Healthcare Provider Details

I. General information

NPI: 1336532159
Provider Name (Legal Business Name): MONE SHAW BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N MAPLE DR
BEVERLY HILLS CA
90210-3428
US

IV. Provider business mailing address

325 N MAPLE DR
BEVERLY HILLS CA
90210-3428
US

V. Phone/Fax

Practice location:
  • Phone: 949-607-8187
  • Fax: 310-651-1999
Mailing address:
  • Phone: 949-607-8187
  • Fax: 310-651-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11727928
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: