Provider Demographics
NPI:1760094072
Name:ETTINGER, PAUL HOWARD (BCBA)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:HOWARD
Last Name:ETTINGER
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 1:4428 MOORPARK WAY APT 3
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2424
Mailing Address - Country:US
Mailing Address - Phone:908-839-8563
Mailing Address - Fax:
Practice Address - Street 1:5554 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2200
Practice Address - Country:US
Practice Address - Phone:818-705-5522
Practice Address - Fax:888-882-7527
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-20-43645103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst