Provider Demographics
NPI:1457916892
Name:ESTRADA, SYLVIA M (BCBA, MS)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:M
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:BCBA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 BITTERSWEET LN
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-1403
Mailing Address - Country:US
Mailing Address - Phone:323-907-5292
Mailing Address - Fax:
Practice Address - Street 1:216 BITTERSWEET LN
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-1403
Practice Address - Country:US
Practice Address - Phone:323-907-5292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-16-17214106S00000X
CA1-21-47119103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician