Provider Demographics
NPI:1700572054
Name:KAUFMAN, SHAUNA MARIE (RBT, BCBA)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:MARIE
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:RBT, BCBA
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:MARIE
Other - Last Name:PERRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5202 JOSIE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-2110
Mailing Address - Country:US
Mailing Address - Phone:650-576-5985
Mailing Address - Fax:
Practice Address - Street 1:200 MARINA DR
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6023
Practice Address - Country:US
Practice Address - Phone:562-453-9760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2024-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-23-65056103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst