Provider Demographics
NPI:1942782628
Name:VALENTINE, KEVIN (BCBA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:VALENTINE
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 1:231 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:WOFFORD HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:93285-9799
Mailing Address - Country:US
Mailing Address - Phone:661-440-1739
Mailing Address - Fax:
Practice Address - Street 1:231 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:WOFFORD HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:93285-9799
Practice Address - Country:US
Practice Address - Phone:661-440-1739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14600522OtherCAQH