Provider Demographics
NPI:1043582141
Name:SUEN, TERESA (BCBA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:SUEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6059 BRISTOL PKWY
Mailing Address - Street 2:#100
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6663
Mailing Address - Country:US
Mailing Address - Phone:866-278-1520
Mailing Address - Fax:
Practice Address - Street 1:6059 BRISTOL PKWY
Practice Address - Street 2:#100
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6663
Practice Address - Country:US
Practice Address - Phone:866-278-1520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-8768103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst