Provider Demographics
NPI:1063063782
Name:DURKIN, VANESSA LYNN (BCBA)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:LYNN
Last Name:DURKIN
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 1:725 SAN CRISTOVAL CT
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-7801
Mailing Address - Country:US
Mailing Address - Phone:408-605-2494
Mailing Address - Fax:
Practice Address - Street 1:474 BLOSSOM HILL RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3301
Practice Address - Country:US
Practice Address - Phone:408-826-4828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-19-37696103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst