Provider Demographics
NPI:1912381559
Name:BURNS, ROBERT WILLIAM (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILLIAM
Last Name:BURNS
Suffix:
Gender:M
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 1:2019 CURTIS AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-2314
Mailing Address - Country:US
Mailing Address - Phone:661-993-3344
Mailing Address - Fax:
Practice Address - Street 1:2019 CURTIS AVE
Practice Address - Street 2:UNIT A
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-2314
Practice Address - Country:US
Practice Address - Phone:661-993-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-9507103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst