Healthcare Provider Details

I. General information

NPI: 1346474038
Provider Name (Legal Business Name): PAULA MARIE SANTOS PSY.D., BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E FOOTHILL BLVD STE 100
PASADENA CA
91107-3443
US

IV. Provider business mailing address

2700 E FOOTHILL BLVD STE 100
PASADENA CA
91107-3443
US

V. Phone/Fax

Practice location:
  • Phone: 626-824-0982
  • Fax:
Mailing address:
  • Phone: 626-824-0982
  • Fax: 888-717-7674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY25243
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY25243
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: