Provider Demographics
NPI:1225407711
Name:BORLASE, MEGAN (PHD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:
Last Name:BORLASE
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18700 BEACH BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2030
Mailing Address - Country:US
Mailing Address - Phone:714-962-6760
Mailing Address - Fax:
Practice Address - Street 1:18700 BEACH BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2030
Practice Address - Country:US
Practice Address - Phone:714-962-6760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-13-13225103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst