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NPI Code Detail

MEDICARE: DIANA MARIE DICKINSON M.A., BCBA

MEDICARE: DIANA MARIE DICKINSON M.A., BCBA
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
1106S00000XBehavior TechnicianRBT-19-81424CA
2103K00000XBehavior Analyst1-21-49299CA

General Provider Information

NPI Number : 1164981304
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA MARIE DICKINSON M.A., BCBA
Provider Business Mailing Address
First Line : 16782 VON KARMAN AVE STE 11
Second Line :
City : IRVINE
State : CA
Zip : 92606-2417
Country : US
Telephone Number : 855-223-7123
Fax Number :
Provider Business Practice Location Address
First Line : 10680 TREENA ST STE 170
Second Line :
City : SAN DIEGO
State : CA
Zip : 92131-2443
Country : US
Telephone Number : 858-432-4749
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2019
Last Update Date : 09/02/2021

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