Provider Demographics
NPI:1073885034
Name:KOMATSU, CHISATO (BCBA-D, PHD)
Entity type:Individual
Prefix:
First Name:CHISATO
Middle Name:
Last Name:KOMATSU
Suffix:
Gender:
Credentials:BCBA-D, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 BRISTOL PKWY APT 206
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6925
Mailing Address - Country:US
Mailing Address - Phone:213-407-9048
Mailing Address - Fax:
Practice Address - Street 1:10736 JEFFERSON BLVD # 1046
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4933
Practice Address - Country:US
Practice Address - Phone:323-285-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-08-4103103K00000X
CA28666103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist