Provider Demographics
NPI:1992492003
Name:MALLARI, ELAINE ROSEMARY (BCBA)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:ROSEMARY
Last Name:MALLARI
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 1:1000 PASEO CAMARILLO STE 235
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-0754
Mailing Address - Country:US
Mailing Address - Phone:805-407-8389
Mailing Address - Fax:
Practice Address - Street 1:1000 PASEO CAMARILLO STE 235
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-0754
Practice Address - Country:US
Practice Address - Phone:805-407-8389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12365031103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst