Provider Demographics
NPI:1497380679
Name:CONDE, ANNETTE (BCBA)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:CONDE
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 1:5910 E WALTON ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1352
Mailing Address - Country:US
Mailing Address - Phone:562-968-8194
Mailing Address - Fax:
Practice Address - Street 1:1503 S COAST DR STE 212
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1556
Practice Address - Country:US
Practice Address - Phone:562-968-8194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-08
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-19-38779103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst