Provider Demographics
NPI:1649785916
Name:RADDEN, TIMICA ROSSETTA (BCBA)
Entity type:Individual
Prefix:MRS
First Name:TIMICA
Middle Name:ROSSETTA
Last Name:RADDEN
Suffix:
Gender:F
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:PO BOX 2137
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-2137
Mailing Address - Country:US
Mailing Address - Phone:760-801-2015
Mailing Address - Fax:
Practice Address - Street 1:26907 SAINT ANDREWS LN
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:CA
Practice Address - Zip Code:92082-6662
Practice Address - Country:US
Practice Address - Phone:760-801-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-17-27933103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst