Provider Demographics
NPI:1134815475
Name:SIERRA, NICOLAS JAMES (RBT)
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:JAMES
Last Name:SIERRA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12253 SW 32ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2236
Mailing Address - Country:US
Mailing Address - Phone:305-761-2025
Mailing Address - Fax:
Practice Address - Street 1:9102 NW 148TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33018-7314
Practice Address - Country:US
Practice Address - Phone:305-761-2025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-267597106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician