Provider Demographics
NPI:1295541233
Name:EATON, BRENDA L (BCBA)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:EATON
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 1:3000 RUBY CREST DR APT 3206
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-8828
Mailing Address - Country:US
Mailing Address - Phone:484-955-4502
Mailing Address - Fax:
Practice Address - Street 1:3000 RUBY CREST DR APT 3206
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-8828
Practice Address - Country:US
Practice Address - Phone:484-955-4502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-10-7767103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst