MEDICARE: DR. AIMEE ELIZABETH ANDERSON PH.D., BCBA-D

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
1	103K00000X	Behavior Analyst	BACB # 1-06-3193	CA
2	103TB0200X	Cognitive & Behavioral Psychologist	PSY 18781	CA
3	103TC2200X	Clinical Child & Adolescent Psychologist	PSY 18781	CA
4	103TM1800X	Intellectual & Developmental Disabilities Psychologist	PSY 18781	CA

General Provider Information

NPI Number	:	1356630602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AIMEE ELIZABETH ANDERSON PH.D., BCBA-D

Provider Business Mailing Address
First Line	:	301 SCIENCE DR
Second Line	:	SUITE 180
City	:	MOORPARK
State	:	CA
Zip	:	93021-2094
Country	:	US
Telephone Number	:	805-529-5265
Fax Number	:	805-529-5267

Provider Business Practice Location Address
First Line	:	301 SCIENCE DR
Second Line	:	SUITE 180
City	:	MOORPARK
State	:	CA
Zip	:	93021-2094
Country	:	US
Telephone Number	:	805-529-5265
Fax Number	:	805-529-5267

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2011
Last Update Date	:	04/06/2011

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