MEDICARE: KATHLEEN ANN ANDRADE BCBA, LBA

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	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
2	103K00000X	Behavior Analyst	LBA0287	NV

General Provider Information

NPI Number	:	1912539032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN ANN ANDRADE BCBA, LBA

Provider Business Mailing Address
First Line	:	6555 AVERILL CREEK AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-6097
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5575 S DURANGO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1833
Country	:	US
Telephone Number	:	702-209-3544
Fax Number	:

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

Provider Enumeration Date	:	02/06/2020
Last Update Date	:	02/06/2020

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