Provider Demographics
NPI:1235537614
Name:MA, LINGDONG (BCBA)
Entity Type:Individual
Prefix:MS
First Name:LINGDONG
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 CRESTSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-2739
Mailing Address - Country:US
Mailing Address - Phone:818-636-8819
Mailing Address - Fax:
Practice Address - Street 1:1950 CRESTSHIRE DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-2739
Practice Address - Country:US
Practice Address - Phone:818-636-8819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-9731103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst