Provider Demographics
NPI:1942697644
Name:COLOMBO, RICHARD ANDREW (BCBA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ANDREW
Last Name:COLOMBO
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 VAN NESS WAY
Mailing Address - Street 2:SUITE 710
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-1489
Mailing Address - Country:US
Mailing Address - Phone:310-517-8505
Mailing Address - Fax:
Practice Address - Street 1:369 VAN NESS WAY
Practice Address - Street 2:SUITE 710
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1489
Practice Address - Country:US
Practice Address - Phone:310-517-8505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-9763103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst