Provider Demographics
NPI:1134907660
Name:LARA, PRISCILLA VANESSA (BCBA)
Entity type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:VANESSA
Last Name:LARA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4826 59TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-5560
Mailing Address - Country:US
Mailing Address - Phone:347-272-6886
Mailing Address - Fax:
Practice Address - Street 1:30 BROAD ST FL 14
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2906
Practice Address - Country:US
Practice Address - Phone:212-512-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst