Provider Demographics
NPI:1316588569
Name:WALD, DEBORAH (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:WALD
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2599 ELMWOOD LN
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-3218
Mailing Address - Country:US
Mailing Address - Phone:701-321-1448
Mailing Address - Fax:
Practice Address - Street 1:12213 PECOS ST STE 200
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-3414
Practice Address - Country:US
Practice Address - Phone:720-459-7493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-20-40829103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst