Provider Demographics
NPI:1184232480
Name:BOCHENSKA, MALGORZATA BEATA (LBA BCBA)
Entity Type:Individual
Prefix:
First Name:MALGORZATA
Middle Name:BEATA
Last Name:BOCHENSKA
Suffix:
Gender:F
Credentials:LBA BCBA
Other - Prefix:
Other - First Name:GOSIA
Other - Middle Name:
Other - Last Name:BOCHENSKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LBA BCBA
Mailing Address - Street 1:631 RIVER OAKS PKWY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-1907
Mailing Address - Country:US
Mailing Address - Phone:408-914-9153
Mailing Address - Fax:
Practice Address - Street 1:631 RIVER OAKS PKWY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134-1907
Practice Address - Country:US
Practice Address - Phone:408-914-9153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT49103K00000X
1-11-8859103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
521590951OtherTAX ID