Provider Demographics
NPI:1417399924
Name:ANDERSON, BREANNA LEIGH (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:LEIGH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 S MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-5212
Mailing Address - Country:US
Mailing Address - Phone:619-442-1271
Mailing Address - Fax:619-444-8182
Practice Address - Street 1:411 S MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-5212
Practice Address - Country:US
Practice Address - Phone:619-442-1271
Practice Address - Fax:619-444-8182
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-14009103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst