Provider Demographics
NPI:1346524238
Name:ABOUL-FETOUH, YASSER (BCBA)
Entity Type:Individual
Prefix:
First Name:YASSER
Middle Name:
Last Name:ABOUL-FETOUH
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2868 TELEGRAPH AVE UNIT A
Mailing Address - Street 2:OAKLAND
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3607
Mailing Address - Country:US
Mailing Address - Phone:850-445-7278
Mailing Address - Fax:
Practice Address - Street 1:2868 TELEGRAPH AVE UNIT A
Practice Address - Street 2:OAKLAND
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3607
Practice Address - Country:US
Practice Address - Phone:850-445-7278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-09-5696103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst