Provider Demographics
NPI:1053664466
Name:BAINS, SURABHI (BCBA)
Entity Type:Individual
Prefix:
First Name:SURABHI
Middle Name:
Last Name:BAINS
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 1:38794 BUCKBOARD CMN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4263
Mailing Address - Country:US
Mailing Address - Phone:510-796-2686
Mailing Address - Fax:
Practice Address - Street 1:38794 BUCKBOARD CMN
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4263
Practice Address - Country:US
Practice Address - Phone:510-796-2686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1119682103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst