Provider Demographics
NPI:1043712052
Name:GREEN, ANGELA CATHERINE (BCBA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:CATHERINE
Last Name:GREEN
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 1:2292 FARADAY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7238
Mailing Address - Country:US
Mailing Address - Phone:626-390-3759
Mailing Address - Fax:855-950-0111
Practice Address - Street 1:2292 FARADAY AVE STE 100
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7238
Practice Address - Country:US
Practice Address - Phone:626-390-3759
Practice Address - Fax:855-950-0111
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-20-45623103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst