Provider Demographics
NPI:1851936694
Name:MORENO, JANELLE DOROTHY (BCBA)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:DOROTHY
Last Name:MORENO
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:PO BOX 901033
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93590-1033
Mailing Address - Country:US
Mailing Address - Phone:661-802-2605
Mailing Address - Fax:
Practice Address - Street 1:27240 TURNBERRY LN STE 200
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1045
Practice Address - Country:US
Practice Address - Phone:818-600-8758
Practice Address - Fax:818-600-8758
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA1-21-55122103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
000OtherN/A