Provider Demographics
NPI:1821417783
Name:BARD, BIBIAN (BCBA)
Entity Type:Individual
Prefix:
First Name:BIBIAN
Middle Name:
Last Name:BARD
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 E 39TH AVE APT C
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-3543
Mailing Address - Country:US
Mailing Address - Phone:650-759-2440
Mailing Address - Fax:
Practice Address - Street 1:22 E 39TH AVE APT C
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-3543
Practice Address - Country:US
Practice Address - Phone:650-759-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-21406103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst