Provider Demographics
NPI:1043950421
Name:KERR, OLIVIA LUXANNA MARIAH (RBT)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:LUXANNA MARIAH
Last Name:KERR
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:LIV
Other - Middle Name:LUXANNA MARIAH
Other - Last Name:KERR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8300 JEFFERSON ST NE STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1734
Mailing Address - Country:US
Mailing Address - Phone:314-834-8010
Mailing Address - Fax:
Practice Address - Street 1:8300 JEFFERSON ST NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1734
Practice Address - Country:US
Practice Address - Phone:314-834-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-22-208019106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBACB773395OtherBACB RBT CERTIFICATION