Provider Demographics
NPI:1477097038
Name:HARDWICK, LEANN TERESE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:TERESE
Last Name:HARDWICK
Suffix:
Gender:F
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 1:1230 ROSECRANS AVE
Mailing Address - Street 2:STE. 250
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2477
Mailing Address - Country:US
Mailing Address - Phone:310-562-2137
Mailing Address - Fax:
Practice Address - Street 1:1230 ROSECRANS AVE
Practice Address - Street 2:STE. 250
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2477
Practice Address - Country:US
Practice Address - Phone:310-562-2137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-15485103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-14-15485OtherBCBA