Provider Demographics
NPI:1134586894
Name:STEVENS, SIMONE (BCABA)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 W SLAUSON AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6576
Mailing Address - Country:US
Mailing Address - Phone:310-410-4450
Mailing Address - Fax:310-410-4455
Practice Address - Street 1:5601 W SLAUSON AVE STE 266
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6692
Practice Address - Country:US
Practice Address - Phone:310-410-4450
Practice Address - Fax:310-410-4455
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst