Provider Demographics
NPI:1104188499
Name:MCRORY BEHAVIORAL & FAMILY SUPPORT SERVICES
Entity Type:Organization
Organization Name:MCRORY BEHAVIORAL & FAMILY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ABA SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:818-501-8352
Mailing Address - Street 1:17609 VENTURA BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-5126
Mailing Address - Country:US
Mailing Address - Phone:818-501-8352
Mailing Address - Fax:
Practice Address - Street 1:17609 VENTURA BLVD STE 215
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5126
Practice Address - Country:US
Practice Address - Phone:818-501-8352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-11-9432103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty