Provider Demographics
NPI:1942617790
Name:BOTZBACH, JANICE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:BOTZBACH
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 1:1912 N BROADWAY STE 108
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2621
Mailing Address - Country:US
Mailing Address - Phone:714-581-8660
Mailing Address - Fax:714-955-4397
Practice Address - Street 1:1912 N. BROADWAY SUITE 108
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706
Practice Address - Country:US
Practice Address - Phone:714-581-8660
Practice Address - Fax:714-955-4397
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-14995103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13855358OtherCAQH
CA1-13-14995OtherBCBA