Healthcare Provider Details

I. General information

NPI: 1194226084
Provider Name (Legal Business Name): BRITANY NICOLE HARDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 12/22/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 HARRISON ST
OAKLAND CA
94612-3520
US

IV. Provider business mailing address

1452 LEON LN
LINCOLN CA
95648-8848
US

V. Phone/Fax

Practice location:
  • Phone: 925-307-0510
  • Fax:
Mailing address:
  • Phone: 925-487-6865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-38079
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-49583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: