Provider Demographics
NPI:1023434636
Name:CRUMPECKER, ANNA (MS, BCBA)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:CRUMPECKER
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 1:455 ESPLANADE AVE
Mailing Address - Street 2:APARTMENT 3
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1853
Mailing Address - Country:US
Mailing Address - Phone:636-259-0918
Mailing Address - Fax:
Practice Address - Street 1:1166 TRITON DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-1289
Practice Address - Country:US
Practice Address - Phone:650-627-8045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst