Healthcare Provider Details

I. General information

NPI: 1275195448
Provider Name (Legal Business Name): CYNTHIA ANN ELLSWORTH BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CINDY ANN ELLSWORTH BCBA

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3532 RABBIT RUN TRL
ADAMS TN
37010-8021
US

IV. Provider business mailing address

18726 S WESTERN AVE
GARDENA CA
90248-3813
US

V. Phone/Fax

Practice location:
  • Phone: 661-964-9893
  • Fax:
Mailing address:
  • Phone: 310-856-0800
  • Fax: 855-568-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-36213
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: