Provider Demographics
NPI:1740597012
Name:MADER, HELEN PHAEDRA (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:PHAEDRA
Last Name:MADER
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 1:18726 S WESTERN AVE
Mailing Address - Street 2:SUITE 408
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-3813
Mailing Address - Country:US
Mailing Address - Phone:310-856-0800
Mailing Address - Fax:310-324-3134
Practice Address - Street 1:18726 S WESTERN AVE
Practice Address - Street 2:SUITE 408
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-3813
Practice Address - Country:US
Practice Address - Phone:310-856-0800
Practice Address - Fax:310-324-3134
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-04-1503103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst