Provider Demographics
NPI:1134492705
Name:NAMANJA, KELLY (BCBA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:NAMANJA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:HANLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:2550 N HOLLYWOOD WAY
Mailing Address - Street 2:#304
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-1055
Mailing Address - Country:US
Mailing Address - Phone:866-278-5011
Mailing Address - Fax:
Practice Address - Street 1:2550 N HOLLYWOOD WAY
Practice Address - Street 2:#304
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-1055
Practice Address - Country:US
Practice Address - Phone:866-278-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-09-5764103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst