Provider Demographics
NPI:1659969749
Name:GAGEBY, CHARLES (BCBA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:GAGEBY
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15353 WEDDINGTON ST APT D211
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-3846
Mailing Address - Country:US
Mailing Address - Phone:605-280-1797
Mailing Address - Fax:
Practice Address - Street 1:15353 WEDDINGTON ST APT D211
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91411-3846
Practice Address - Country:US
Practice Address - Phone:605-280-1797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst