Provider Demographics
NPI:1497378178
Name:LOPEZ, SHARI JO (BCBA)
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:JO
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 E HOSPITALITY LN STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3545
Mailing Address - Country:US
Mailing Address - Phone:909-891-1599
Mailing Address - Fax:877-306-6790
Practice Address - Street 1:560 E HOSPITALITY LN STE 400
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3545
Practice Address - Country:US
Practice Address - Phone:909-891-1599
Practice Address - Fax:877-306-6790
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-20-45514103K00000X, 103K00000X
WAAB61029400106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst