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NPI Code Detail

MEDICARE: SAMANTHA DEROSE BCBA

MEDICARE: SAMANTHA DEROSE BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-17-29118CA
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1144633827
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA DEROSE BCBA
Provider Business Mailing Address
First Line : 1815 E HEIM AVE STE 205
Second Line :
City : ORANGE
State : CA
Zip : 92865-3016
Country : US
Telephone Number : 171-640-6891
Fax Number :
Provider Business Practice Location Address
First Line : 1815 E HEIM AVE STE 205
Second Line :
City : ORANGE
State : CA
Zip : 92865-3016
Country : US
Telephone Number : 714-640-6891
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2014
Last Update Date : 11/28/2023

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Directions to “ SAMANTHA DEROSE BCBA” Practice Location

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