Provider Demographics
NPI:1699132985
Name:ANDERSON, KARRIE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:KARRIE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 VIA CORZO
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-7318
Mailing Address - Country:US
Mailing Address - Phone:714-396-7290
Mailing Address - Fax:
Practice Address - Street 1:4820 VIA CORZO
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-7318
Practice Address - Country:US
Practice Address - Phone:714-396-7290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-16660103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst