Healthcare Provider Details

I. General information

NPI: 1972895076
Provider Name (Legal Business Name): ALBERT ADAM KNAPP JR. PSY.D., LP, BCBA-D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2011
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 AVIATION BLVD SUITE 102
REDONDO BEACH CA
90278-4001
US

IV. Provider business mailing address

2711 N SEPULVEDA BLVD SUITE 286
MANHATTAN BEACH CA
90266-2725
US

V. Phone/Fax

Practice location:
  • Phone: 310-210-2779
  • Fax:
Mailing address:
  • Phone: 310-210-2779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number25873
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-08-4806
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: