Healthcare Provider Details

I. General information

NPI: 1386171007
Provider Name (Legal Business Name): THE ATEAM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3575 LEHIGH DR APT 13
SANTA CLARA CA
95051-6073
US

IV. Provider business mailing address

3575 LEHIGH DR APARTMENT 13
SANTA CLARA CA
95051-6072
US

V. Phone/Fax

Practice location:
  • Phone: 408-916-7344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1107474
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY27356
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1107474
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1107474
License Number StateCA

VIII. Authorized Official

Name: JAMES DE QUINTO
Title or Position: MANAGER & BEHAVIOR ANALYST
Credential: MS, BCBA
Phone: 408-916-7344