Provider Demographics
NPI:1144941162
Name:TOBDZIC, ANNELIES (BCBA)
Entity type:Individual
Prefix:MRS
First Name:ANNELIES
Middle Name:
Last Name:TOBDZIC
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MISS
Other - First Name:ANNELIES
Other - Middle Name:
Other - Last Name:OVERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:915 TREBBIANO CT
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-2099
Mailing Address - Country:US
Mailing Address - Phone:201-675-2220
Mailing Address - Fax:
Practice Address - Street 1:2000 POWELL ST STE 900
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-1888
Practice Address - Country:US
Practice Address - Phone:510-542-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-56545103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst