Provider Demographics
NPI:1942742689
Name:DREW, DANIELLE E (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:E
Last Name:DREW
Suffix:
Gender:F
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 1:41334 BRAVOS CT
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-1544
Mailing Address - Country:US
Mailing Address - Phone:951-970-6145
Mailing Address - Fax:
Practice Address - Street 1:255 E RINCON ST
Practice Address - Street 2:SUITE 219
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1367
Practice Address - Country:US
Practice Address - Phone:951-817-5328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-15790103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst