Provider Demographics
NPI:1063835858
Name:COENEN, DAHLIA (BCABA, MA)
Entity type:Individual
Prefix:
First Name:DAHLIA
Middle Name:
Last Name:COENEN
Suffix:
Gender:F
Credentials:BCABA, MA
Other - Prefix:
Other - First Name:VITTORIA
Other - Middle Name:
Other - Last Name:PAIGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1901 CARNEGIE AVE STE 1C
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5504
Mailing Address - Country:US
Mailing Address - Phone:800-273-4292
Mailing Address - Fax:949-253-4627
Practice Address - Street 1:1901 CARNEGIE AVE STE 1C
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5504
Practice Address - Country:US
Practice Address - Phone:800-273-4292
Practice Address - Fax:949-253-4627
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-13-5746103K00000X
OR0-13-5746106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst