Basic Information
Provider Information | |||||||||
NPI: | 1508233388 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SANDERS | ||||||||
FirstName: | DEBORAH | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.ED., BCBA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 154 PASEO DE LA CONCHA | ||||||||
Address2: | APT. D | ||||||||
City: | REDONDO BEACH | ||||||||
State: | CA | ||||||||
PostalCode: | 902776247 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3109948969 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1230 ROSECRANS AVE STE 250 | ||||||||
Address2: |   | ||||||||
City: | MANHATTAN BEACH | ||||||||
State: | CA | ||||||||
PostalCode: | 902662496 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3104061500 | ||||||||
FaxNumber: | 3104061500 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/27/2015 | ||||||||
LastUpdateDate: | 08/27/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | BCBA 1-14-17731 | CA | Y |   | Behavioral Health & Social Service Providers | Behavioral Analyst |   |
No ID Information.