Healthcare Provider Details

I. General information

NPI: 1093449555
Provider Name (Legal Business Name): CLAYWORKS 4 KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 S NORMA LN
ANAHEIM CA
92802-3228
US

IV. Provider business mailing address

2020 S NORMA LN
ANAHEIM CA
92802-3228
US

V. Phone/Fax

Practice location:
  • Phone: 949-554-4062
  • Fax: 949-203-6114
Mailing address:
  • Phone: 949-554-4062
  • Fax: 949-203-6114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ALICIA FERNANDEZ
Title or Position: BOARD CERTIFIED BEHAVIORAL ANALYSIS
Credential: BCBA
Phone: 949-554-4062