Provider Demographics
NPI:1215391131
Name:ROBLES, KACIE ANNE (BCBA-M)
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:ANNE
Last Name:ROBLES
Suffix:
Gender:F
Credentials:BCBA-M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25042
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-5042
Mailing Address - Country:US
Mailing Address - Phone:559-475-7860
Mailing Address - Fax:
Practice Address - Street 1:1630 E SHAW AVE
Practice Address - Street 2:STE. 190
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8105
Practice Address - Country:US
Practice Address - Phone:559-475-7860
Practice Address - Fax:559-475-7862
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-22053103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst