Provider Demographics
NPI:1245516087
Name:CHURCHILL, ROBERT (BCBA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:CHURCHILL
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 1:5729 SONOMA DR
Mailing Address - Street 2:SUITE K
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7782
Mailing Address - Country:US
Mailing Address - Phone:650-464-3409
Mailing Address - Fax:925-484-9992
Practice Address - Street 1:5729 SONOMA DR
Practice Address - Street 2:SUITE K
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-7782
Practice Address - Country:US
Practice Address - Phone:650-464-3409
Practice Address - Fax:925-484-9992
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-03-1247103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst