Provider Demographics
NPI:1952774028
Name:ANDERSON, RENEE LEA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:LEA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9438 LA SUVIDA DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3943
Mailing Address - Country:US
Mailing Address - Phone:619-708-4691
Mailing Address - Fax:
Practice Address - Street 1:4204 ADAMS AVE.
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-3943
Practice Address - Country:US
Practice Address - Phone:619-708-4691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst