Provider Demographics
NPI:1003258179
Name:SUNDERLIN BEHAVIORAL INTERVENTIONS
Entity Type:Organization
Organization Name:SUNDERLIN BEHAVIORAL INTERVENTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YRENKA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOLLI-SUNDERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:805-208-3875
Mailing Address - Street 1:365 E AVENIDA DE LOS ARBOLES
Mailing Address - Street 2:#270
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-2975
Mailing Address - Country:US
Mailing Address - Phone:805-208-3875
Mailing Address - Fax:805-823-4462
Practice Address - Street 1:365 E AVENIDA DE LOS ARBOLES
Practice Address - Street 2:#270
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-2975
Practice Address - Country:US
Practice Address - Phone:805-208-3875
Practice Address - Fax:805-823-4462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-18
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-10-6753103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty