Provider Demographics
NPI:1336367366
Name:KASIMIAN, ANDREA KATHLEEN (BCBA, DC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:KATHLEEN
Last Name:KASIMIAN
Suffix:
Gender:F
Credentials:BCBA, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6059 BRISTOL PKWY
Mailing Address - Street 2:#100
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6663
Mailing Address - Country:US
Mailing Address - Phone:866-278-1520
Mailing Address - Fax:
Practice Address - Street 1:6059 BRISTOL PKWY
Practice Address - Street 2:#100
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6663
Practice Address - Country:US
Practice Address - Phone:866-278-1520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30484111N00000X
1-11-8664103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No111N00000XChiropractic ProvidersChiropractor