Provider Demographics
NPI:1780213306
Name:SUCCA, KRISTEEN MARIE (MS, BCBA)
Entity Type:Individual
Prefix:MS
First Name:KRISTEEN
Middle Name:MARIE
Last Name:SUCCA
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 PARK CENTER DR STE D
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-6200
Mailing Address - Country:US
Mailing Address - Phone:805-416-3384
Mailing Address - Fax:
Practice Address - Street 1:2665 PARK CENTER DR STE D
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-6200
Practice Address - Country:US
Practice Address - Phone:805-416-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-19-39682103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst