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General NPI Number Information
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NPI Number | 1538662804
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Entity Type | Organization
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Legal Business Name | SANDWELL ABA LLC
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 03/13/2018
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Provider Practice Location Address
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Address Line | 95-390 KUAHELANI AVE SUITE 3AC #1082
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City | MILILANI
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State | HI
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Zip | 96789-1190
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Country | US
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Telephone | 858-247-1828
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Fax |
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Provider Business Mailing Address
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Address Line | 95-390 KUAHELANI AVE SUITE 3AC #1082
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City | MILILANI
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State | HI
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Zip | 96789-1190
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MELISSA SANDWELL
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Credential | MA, BCBA
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Telephone | 858-247-1828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BA-136
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License Number State | HI
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