Basic Information
| Provider Information | |||||||||
| NPI: | 1023434636 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRUMPECKER | ||||||||
| FirstName: | ANNA | ||||||||
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| Credential: | M.S., BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 ESPLANADE AVE | ||||||||
| Address2: | APARTMENT 3 | ||||||||
| City: | PACIFICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940441853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362590918 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1166 TRITON DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | FOSTER CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944041289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6506278045 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2014 | ||||||||
| LastUpdateDate: | 03/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.