Provider Demographics
NPI:1114535382
Name:BADONI BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:BADONI BEHAVIORAL SERVICES LLC
Other - Org Name:BADONI BEHAVIORAL SERVICES LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PARVATI
Authorized Official - Middle Name:
Authorized Official - Last Name:BADONI
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:408-416-7539
Mailing Address - Street 1:6699 BOGIALA WAY
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-7108
Mailing Address - Country:US
Mailing Address - Phone:408-416-7539
Mailing Address - Fax:408-413-4448
Practice Address - Street 1:3031 TISCH WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2541
Practice Address - Country:US
Practice Address - Phone:408-416-7539
Practice Address - Fax:408-413-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty