Provider Demographics
NPI:1851853196
Name:STARR, MARIA CAROLINA GAERLAN (BCBA)
Entity Type:Individual
Prefix:
First Name:MARIA CAROLINA
Middle Name:GAERLAN
Last Name:STARR
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6235 FULTON AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-2509
Mailing Address - Country:US
Mailing Address - Phone:818-987-1808
Mailing Address - Fax:
Practice Address - Street 1:16946 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3613
Practice Address - Country:US
Practice Address - Phone:818-401-0661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19-35312103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty