Provider Demographics
NPI:1346474038
Name:SANTOS, PAULA MARIE (PSYD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:MARIE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:PSYD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 E FOOTHILL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3443
Mailing Address - Country:US
Mailing Address - Phone:626-824-0982
Mailing Address - Fax:888-717-7674
Practice Address - Street 1:2700 E FOOTHILL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3443
Practice Address - Country:US
Practice Address - Phone:626-824-0982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25243103TB0200X, 103TC2200X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY25243OtherBOARD OF PSYCHOLOGY CERTIFICATE LICENSE NUMBER