Provider Demographics
NPI:1174083968
Name:GERVAIS, MARIA E (BCBA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:GERVAIS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:E
Other - Last Name:CORNISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:PO BOX 17749
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85731-7749
Mailing Address - Country:US
Mailing Address - Phone:520-784-5384
Mailing Address - Fax:520-318-6933
Practice Address - Street 1:401 N BONITA AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2750
Practice Address - Country:US
Practice Address - Phone:520-721-1887
Practice Address - Fax:520-721-0069
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-000437103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBEH-000437OtherARIZONA STATE BOARD OF PSYCHOLOGIST EXAMINERS