Provider Demographics
NPI:1356630602
Name:ANDERSON, AIMEE ELIZABETH (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:ELIZABETH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SCIENCE DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2094
Mailing Address - Country:US
Mailing Address - Phone:805-529-5265
Mailing Address - Fax:805-529-5267
Practice Address - Street 1:301 SCIENCE DR
Practice Address - Street 2:SUITE 180
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2094
Practice Address - Country:US
Practice Address - Phone:805-529-5265
Practice Address - Fax:805-529-5267
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABACB # 1-06-3193103K00000X
CAPSY 18781103TB0200X, 103TC2200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities