Provider Demographics
NPI:1427820208
Name:VAN DEVENTER, ANDREA (BCBA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:VAN DEVENTER
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 1:24595 TOWN CENTER DR APT 3102
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1382
Mailing Address - Country:US
Mailing Address - Phone:818-208-0164
Mailing Address - Fax:
Practice Address - Street 1:22800 LYONS AVE STE 110
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2897
Practice Address - Country:US
Practice Address - Phone:818-208-0164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1-23-65923103K00000X
103K00000X
CA12365923103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst