Provider Demographics
NPI:1720351836
Name:CHRISTOPHERSEN, SERENA (BCBA)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:CHRISTOPHERSEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3425 COFFEE RD
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1582
Mailing Address - Country:US
Mailing Address - Phone:209-521-4791
Mailing Address - Fax:209-521-4794
Practice Address - Street 1:1300 ETHAN WAY
Practice Address - Street 2:SUITE 175
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2211
Practice Address - Country:US
Practice Address - Phone:209-521-4791
Practice Address - Fax:209-521-4794
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA1-09-6395103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst