Provider Demographics
NPI:1568149565
Name:DOUGHER, OLIVIA SCOTT (BCBA)
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:SCOTT
Last Name:DOUGHER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MISS
Other - First Name:OLIVIA
Other - Middle Name:SCOTT
Other - Last Name:MANGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2550 N HOLLYWOOD WAY STE 301
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-5025
Mailing Address - Country:US
Mailing Address - Phone:866-727-8274
Mailing Address - Fax:
Practice Address - Street 1:14550 YORK RD STE A
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:MD
Practice Address - Zip Code:21152-9307
Practice Address - Country:US
Practice Address - Phone:443-330-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJBACB412074103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst