MEDICARE: JANINE STRACK M.S., 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
1	103K00000X	Behavior Analyst	1-09-5813	CA

General Provider Information

NPI Number	:	1518369982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANINE STRACK M.S., BCBA

Provider Business Mailing Address
First Line	:	2447 PACIFIC COAST HWY STE 111
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-2743
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2447 PACIFIC COAST HWY STE 111
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-2743
Country	:	US
Telephone Number	:	310-374-3300
Fax Number	:	310-374-3307

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

Provider Enumeration Date	:	09/17/2014
Last Update Date	:	02/04/2020

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