Healthcare Provider Details

I. General information

NPI: 1851658926
Provider Name (Legal Business Name): MARYAM ABEDI PHD, BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2082 BUSINESS CENTER DR #282
IRVINE CA
92612-1129
US

IV. Provider business mailing address

2082 BUSINESS CENTER DR #282
IRVINE CA
92612-1129
US

V. Phone/Fax

Practice location:
  • Phone: 949-250-1101
  • Fax: 949-250-1103
Mailing address:
  • Phone: 949-250-1101
  • Fax: 949-250-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 40319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: