Provider Demographics
NPI:1679023105
Name:SIMKIN, ANGELA NICOLE (BCABA)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:NICOLE
Last Name:SIMKIN
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:NICOLE
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3200 ZANKER RD
Mailing Address - Street 2:UNIT 1428
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-1943
Mailing Address - Country:US
Mailing Address - Phone:510-219-9241
Mailing Address - Fax:
Practice Address - Street 1:3200 ZANKER RD
Practice Address - Street 2:UNIT 1428
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134-1943
Practice Address - Country:US
Practice Address - Phone:510-219-9241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-16-7392106E00000X
CA16-12782106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician