MEDICARE: EMILY STEVENS FALKENSTEIN M.A., 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
1	103K00000X	Behavior Analyst	1-14-15367	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1962726752	OTHER	CA	NPPES

General Provider Information

NPI Number	:	1760883250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY STEVENS FALKENSTEIN M.A., BCBA

Provider Business Mailing Address
First Line	:	35 24TH AVE APT 4
Second Line	:
City	:	VENICE
State	:	CA
Zip	:	90291-4364
Country	:	US
Telephone Number	:	310-422-3695
Fax Number	:

Provider Business Practice Location Address
First Line	:	3424 MOTOR AVE STE 101
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-4710
Country	:	US
Telephone Number	:	310-422-3695
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2014
Last Update Date	:	09/15/2014

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