Provider Demographics
NPI:1952675522
Name:SUCKARIEH, NADIA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:SUCKARIEH
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4832 CALMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5315
Mailing Address - Country:US
Mailing Address - Phone:432-352-6198
Mailing Address - Fax:
Practice Address - Street 1:4832 CALMONT AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5315
Practice Address - Country:US
Practice Address - Phone:432-352-6198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-12-10471103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst