Healthcare Provider Details

I. General information

NPI: 1629611652
Provider Name (Legal Business Name): MARYSEL NICOLE DONATO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 E BIRCH ST STE 102
BREA CA
92821-6261
US

IV. Provider business mailing address

3000 E BIRCH ST STE 102
BREA CA
92821-6261
US

V. Phone/Fax

Practice location:
  • Phone: 657-444-9002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: