Provider Demographics
NPI:1972061810
Name:SIERRA FERNANDEZ, MARTHA ELENA (BCBA)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ELENA
Last Name:SIERRA FERNANDEZ
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 1:3209 VILLAGE OAK DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-2532
Mailing Address - Country:US
Mailing Address - Phone:786-306-9184
Mailing Address - Fax:
Practice Address - Street 1:3209 VILLAGE OAK DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-2532
Practice Address - Country:US
Practice Address - Phone:786-306-9184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL1-22-62168103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician