Healthcare Provider Details

I. General information

NPI: 1760758841
Provider Name (Legal Business Name): ARLENE LEBRILLA BERLIN MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ARLENE JOY LAVILLA LEBRILLA MS, BCBA

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17203 VENTURA BLVD SUITE 3
ENCINO CA
91316-4051
US

IV. Provider business mailing address

17203 VENTURA BLVD SUITE 3
ENCINO CA
91316-4051
US

V. Phone/Fax

Practice location:
  • Phone: 818-501-3615
  • Fax: 818-501-3649
Mailing address:
  • Phone: 818-501-3615
  • Fax: 818-501-3649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17391
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-10-7088
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: