Provider Demographics
NPI:1972271666
Name:HERRERA, ALICE (BCBA)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:HERRERA
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 1:16600 SHERMAN WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3876
Mailing Address - Country:US
Mailing Address - Phone:818-991-7722
Mailing Address - Fax:818-991-7722
Practice Address - Street 1:1445 CELIS ST
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-3207
Practice Address - Country:US
Practice Address - Phone:818-741-1299
Practice Address - Fax:818-991-7722
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-21-12504106E00000X
CA1-21-54477103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst