Basic Information
| Provider Information | |||||||||
| NPI: | 1790118552 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARIN | ||||||||
| FirstName: | CASEY | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21600 OXNARD ST | ||||||||
| Address2: | SUITE 1800 | ||||||||
| City: | WOODLAND HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913674976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183452345 | ||||||||
| FaxNumber: | 8184490994 | ||||||||
| Practice Location | |||||||||
| Address1: | 129 NE 102ND AVE | ||||||||
| Address2: | SUITE E | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972204102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032546317 | ||||||||
| FaxNumber: | 3608368131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2013 | ||||||||
| LastUpdateDate: | 05/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-13-14088 | NC | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.