Healthcare Provider Details

I. General information

NPI: 1811432289
Provider Name (Legal Business Name): ANNA DOBIE GOLDFARB BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 SW BARBUR BLVD BLDG 2
PORTLAND OR
97219-2823
US

IV. Provider business mailing address

PO BOX 767938
ROSWELL GA
30076-7938
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-6780
  • Fax: 800-819-7806
Mailing address:
  • Phone: 818-241-6780
  • Fax: 800-819-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberABA-B-10212851
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: