Provider Demographics
NPI:1366948739
Name:COLLINS, CASSANDRA (BCBA)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:COLLINS
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 1:20729 CASHEW ST
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-8984
Mailing Address - Country:US
Mailing Address - Phone:323-309-8189
Mailing Address - Fax:
Practice Address - Street 1:20729 CASHEW ST
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-8984
Practice Address - Country:US
Practice Address - Phone:323-309-8189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-20-41967103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst