Provider Demographics
NPI:1740997907
Name:CHANG, BIANCA HAILEY (BCBA, LBA)
Entity type:Individual
Prefix:MS
First Name:BIANCA
Middle Name:HAILEY
Last Name:CHANG
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1100 PUAHALA STREET
Mailing Address - Street 2:UNIT R
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2146
Mailing Address - Country:US
Mailing Address - Phone:808-391-3220
Mailing Address - Fax:
Practice Address - Street 1:46-169 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3651
Practice Address - Country:US
Practice Address - Phone:808-784-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIBA-458103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst