Provider Demographics
NPI:1215328133
Name:HAMEDI, ANTHONY (BCBA)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:HAMEDI
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ALMERIA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5347
Mailing Address - Country:US
Mailing Address - Phone:949-214-8976
Mailing Address - Fax:
Practice Address - Street 1:8 ALMERIA
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-5347
Practice Address - Country:US
Practice Address - Phone:949-214-8976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-14-10126103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst