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NPI Code Detail

MEDICARE: MRS. DHALYS RAEANNE TRINITY MCCLURE BCBA

MEDICARE: MRS. DHALYS RAEANNE TRINITY MCCLURE 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
1106S00000XBehavior TechnicianCA
2103K00000XBehavior Analyst1-23-70441CA

General Provider Information

NPI Number : 1841793023
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DHALYS RAEANNE TRINITY MCCLURE BCBA
Provider Business Mailing Address
First Line : 110 RYAN INDUSTRIAL CT STE 3&4
Second Line :
City : SAN RAMON
State : CA
Zip : 94583-1592
Country : US
Telephone Number : 510-315-6600
Fax Number :
Provider Business Practice Location Address
First Line : 110 RYAN INDUSTRIAL CT STE 3&4
Second Line :
City : SAN RAMON
State : CA
Zip : 94583-1592
Country : US
Telephone Number : 510-315-6600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2018
Last Update Date : 04/08/2025

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