Healthcare Provider Details

I. General information

NPI: 1760795959
Provider Name (Legal Business Name): SHARYN LEE KERR BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16782 VON KARMAN AVE
IRVINE CA
92606-9928
US

IV. Provider business mailing address

16782 VON KARMAN AVE
IRVINE CA
92606-9928
US

V. Phone/Fax

Practice location:
  • Phone: 949-833-2237
  • Fax: 949-833-2230
Mailing address:
  • Phone: 949-833-2237
  • Fax: 949-833-2230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1073568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: