Provider Demographics
NPI:1992187512
Name:LAM, LEIMALYN INONG-REALINA (BCBA)
Entity Type:Individual
Prefix:
First Name:LEIMALYN
Middle Name:INONG-REALINA
Last Name:LAM
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:LEIMALYN
Other - Middle Name:INONG
Other - Last Name:REALINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DEPT LA 22763
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-2763
Mailing Address - Country:US
Mailing Address - Phone:866-523-4268
Mailing Address - Fax:
Practice Address - Street 1:2230 LONGPORT CT STE 130
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7182
Practice Address - Country:US
Practice Address - Phone:866-523-4268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst