Healthcare Provider Details

I. General information

NPI: 1821925298
Provider Name (Legal Business Name): OLGA SHAPOVALOVA M.S., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 ROSEMONT AVE
LA CRESCENTA CA
91214-3142
US

IV. Provider business mailing address

4630 ROSEMONT AVE
LA CRESCENTA CA
91214-3142
US

V. Phone/Fax

Practice location:
  • Phone: 626-641-0963
  • Fax:
Mailing address:
  • Phone: 626-641-0963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-09-6344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: