Healthcare Provider Details

I. General information

NPI: 1942766175
Provider Name (Legal Business Name): MONICA CHAVARRIA BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11103 WEST AVE STE 108
SAN ANTONIO TX
78213-4915
US

IV. Provider business mailing address

14131 MIDWAY RD STE 800
ADDISON TX
75001-3627
US

V. Phone/Fax

Practice location:
  • Phone: 210-340-2627
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberRBT-17-41108
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number4876
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: