Provider Demographics
NPI:1154749018
Name:RYAN MARCUS, CAITLIN (BCBA)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:RYAN MARCUS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:MARCUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:13440 VENTURA BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3850
Mailing Address - Country:US
Mailing Address - Phone:818-442-0921
Mailing Address - Fax:
Practice Address - Street 1:13440 VENTURA BLVD
Practice Address - Street 2:STE 200
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-3850
Practice Address - Country:US
Practice Address - Phone:818-442-0921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABCBA: 1-14-15593103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12670630OtherCAQH