Provider Demographics
NPI:1275244600
Name:VELASCO, ANDREA FERNANDA (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:FERNANDA
Last Name:VELASCO
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:VELASCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:9926 WOODLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-1344
Mailing Address - Country:US
Mailing Address - Phone:818-984-5712
Mailing Address - Fax:
Practice Address - Street 1:2829 W BURBANK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2300
Practice Address - Country:US
Practice Address - Phone:818-669-2679
Practice Address - Fax:833-607-5471
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-21-54876103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst