Provider Demographics
NPI:1417345752
Name:CLEARY, JAMES (MS-BCBA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:CLEARY
Suffix:
Gender:M
Credentials:MS-BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 HUNTINGTON DR
Mailing Address - Street 2:305
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-2580
Mailing Address - Country:US
Mailing Address - Phone:626-531-6999
Mailing Address - Fax:
Practice Address - Street 1:1740 HUNTINGTON DR.,
Practice Address - Street 2:305
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-2580
Practice Address - Country:US
Practice Address - Phone:626-531-6999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11211551103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst