Basic Information
| Provider Information | |||||||||
| NPI: | 1033870076 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VIELMAN | ||||||||
| FirstName: | ROGER | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4880 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930037783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056587545 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15360 VENTURA BLVD | ||||||||
| Address2: | SUITE 1140 | ||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189867827 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2022 | ||||||||
| LastUpdateDate: | 01/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-21-56315 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.