Provider Demographics
NPI:1912472937
Name:NELL, ANDREA (BCBA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:NELL
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 1:6167 BRISTOL PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6611
Mailing Address - Country:US
Mailing Address - Phone:310-410-4450
Mailing Address - Fax:
Practice Address - Street 1:6167 BRISTOL PKWY STE 130
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6611
Practice Address - Country:US
Practice Address - Phone:310-410-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst