Provider Demographics
NPI:1346643731
Name:CUMMINGS, KRISTEN (BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:CUMMINGS
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 1:3645 CARDIFF AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-7805
Mailing Address - Country:US
Mailing Address - Phone:310-821-0963
Mailing Address - Fax:310-821-3264
Practice Address - Street 1:5433 BEETHOVEN ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-7016
Practice Address - Country:US
Practice Address - Phone:310-821-0963
Practice Address - Fax:310-821-3264
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-14924103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst