Healthcare Provider Details

I. General information

NPI: 1225463177
Provider Name (Legal Business Name): CENTER FOR BEHAVIOR ANALYSIS AND LANGUAGE DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 5TH ST
MANHATTAN BEACH CA
90266-5713
US

IV. Provider business mailing address

405 5TH ST
MANHATTAN BEACH CA
90266-5713
US

V. Phone/Fax

Practice location:
  • Phone: 310-310-2931
  • Fax: 323-747-7023
Mailing address:
  • Phone: 310-310-2931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number6625
License Number StateOH

VIII. Authorized Official

Name: DANIEL SHABANI
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D., BCBA-D
Phone: 310-310-2097