Provider Demographics
NPI:1487920054
Name:INSTITUTE FOR APPLIED BEHAVIOR ANALYSIS
Entity type:Organization
Organization Name:INSTITUTE FOR APPLIED BEHAVIOR ANALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-649-0499
Mailing Address - Street 1:5777 W CENTURY BLVD STE 675
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5632
Mailing Address - Country:US
Mailing Address - Phone:310-649-0499
Mailing Address - Fax:
Practice Address - Street 1:5777 W CENTURY BLVD STE 675
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-5632
Practice Address - Country:US
Practice Address - Phone:310-649-0499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-01-0612103K00000X
CA1-09-6511103K00000X
CA1-11-7967103K00000X
CA1-11-8158103K00000X
CA1-02-0940103K00000X
103K00000X
CAPSY24318103TC2200X
CAPSY5115103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty