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NPI Code Detail

MEDICARE: ELIZABETH DAMIANO M.A., B.C.B.A.

MEDICARE: ELIZABETH DAMIANO M.A., B.C.B.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1154665040
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH DAMIANO M.A., B.C.B.A.
Provider Business Mailing Address
First Line : 6512 MICHELSON ST
Second Line :
City : LAKEWOOD
State : CA
Zip : 90713-1740
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 65 ENTERPRISE
Second Line :
City : ALISO VIEJO
State : CA
Zip : 92656-2705
Country : US
Telephone Number : 866-522-4145
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2012
Last Update Date : 11/16/2012

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