Healthcare Provider Details

I. General information

NPI: 1063101574
Provider Name (Legal Business Name): ASSENT ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 TILTON AVE
SAN MATEO CA
94401-2811
US

IV. Provider business mailing address

118 TILTON AVE
SAN MATEO CA
94401-2811
US

V. Phone/Fax

Practice location:
  • Phone: 650-484-7076
  • Fax:
Mailing address:
  • Phone: 650-484-7076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEPHANIE LYNN FICHTEL
Title or Position: FOUNDER
Credential: M.A., BCBA
Phone: 650-484-7076