Provider Demographics
NPI:1114329240
Name:DAMAJ, ASHLEY ROBERT (MSW, BCBA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ROBERT
Last Name:DAMAJ
Suffix:
Gender:F
Credentials:MSW, BCBA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:CAVETT
Other - Last Name:ROBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, BCBA
Mailing Address - Street 1:2851 CATALPA ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3220
Mailing Address - Country:US
Mailing Address - Phone:949-293-8711
Mailing Address - Fax:
Practice Address - Street 1:2851 CATALPA ST
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3220
Practice Address - Country:US
Practice Address - Phone:949-293-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0135257103K00000X
011519370103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
011519370OtherBACB