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General NPI Number Information
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NPI Number | 1548867542
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Entity Type | Organization
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Legal Business Name | COSMIC CARE ABA
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Dates
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Enumeration Date | 10/03/2020
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Last Update Date | 03/22/2023
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Provider Practice Location Address
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Address Line | 1317 DEL NORTE RD STE 220A
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City | CAMARILLO
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State | CA
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Zip | 93010-8593
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Country | US
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Telephone | 805-415-2441
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Fax | 805-654-9815
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Provider Business Mailing Address
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Address Line | 44 DUVALI DR
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City | VENTURA
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State | CA
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Zip | 93003-2151
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Country | US
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Telephone | 805-415-2441
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KERRY HOFFMAN
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Credential |
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Telephone | 805-415-2441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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