Provider Demographics
NPI:1952833261
Name:MIRCEA, CAMELIA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:CAMELIA
Middle Name:
Last Name:MIRCEA
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 SURBER DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-4341
Mailing Address - Country:US
Mailing Address - Phone:408-690-4474
Mailing Address - Fax:
Practice Address - Street 1:317 SURBER DRIVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-4341
Practice Address - Country:US
Practice Address - Phone:408-690-4474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-22622103K00000X
CA1-16-22622103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty