Provider Demographics
NPI:1922397272
Name:AIMEE E. ANDERSON, PH.D. A PROFESSIONAL PSYCHOLOGY CORPORATION
Entity Type:Organization
Organization Name:AIMEE E. ANDERSON, PH.D. A PROFESSIONAL PSYCHOLOGY CORPORATION
Other - Org Name:AUTISM CENTER FOR TREATMENT (ACT)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D
Authorized Official - Phone:818-707-1717
Mailing Address - Street 1:29525 CANWOOD ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4233
Mailing Address - Country:US
Mailing Address - Phone:818-707-1717
Mailing Address - Fax:818-717-1719
Practice Address - Street 1:29525 CANWOOD ST
Practice Address - Street 2:SUITE 303
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4233
Practice Address - Country:US
Practice Address - Phone:818-707-1717
Practice Address - Fax:818-707-1719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18781252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency