Provider Demographics
NPI:1003575978
Name:RICH, WARNER A (BCBA 12155504)
Entity Type:Individual
Prefix:
First Name:WARNER
Middle Name:A
Last Name:RICH
Suffix:
Gender:F
Credentials:BCBA 12155504
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 TERMINO AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-2660
Mailing Address - Country:US
Mailing Address - Phone:714-548-1761
Mailing Address - Fax:
Practice Address - Street 1:2615 PACIFIC COAST HWY STE 300
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2227
Practice Address - Country:US
Practice Address - Phone:310-765-0604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12155504103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst