Provider Demographics
NPI:1790301935
Name:VALENCIA, SHANNON (BCBA)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:VALENCIA
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 1:4770 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1136
Mailing Address - Country:US
Mailing Address - Phone:646-647-1540
Mailing Address - Fax:
Practice Address - Street 1:11596 MAPLE VIEW PL UNIT A
Practice Address - Street 2:
Practice Address - City:FORT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13603-3506
Practice Address - Country:US
Practice Address - Phone:408-832-3043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-24-75431103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVRBT1211OtherSTATE OF NEVADA BOARD OF APPLIED BEHAVIOR ANALYSIS
RBT-20-118770OtherBEHAVIOR ANALYSIS CERTIFICATION BOARD