Provider Demographics
NPI:1861160327
Name:CHIALA, MARJORIE DANIELLE (BCBA)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:DANIELLE
Last Name:CHIALA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:CHIALA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:3180 IMJIN RD STE 149
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-5111
Mailing Address - Country:US
Mailing Address - Phone:831-786-0600
Mailing Address - Fax:
Practice Address - Street 1:3180 IMJIN RD STE 149
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-5111
Practice Address - Country:US
Practice Address - Phone:831-786-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-21-52465103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst