Provider Demographics
NPI:1053039644
Name:HOANG, ANDREA QUYNH MAI (MA, BCBA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:QUYNH MAI
Last Name:HOANG
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 INTERLOCKEN BLVD APT 4318
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3457
Mailing Address - Country:US
Mailing Address - Phone:512-287-9473
Mailing Address - Fax:
Practice Address - Street 1:401 INTERLOCKEN BLVD APT 4318
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-3457
Practice Address - Country:US
Practice Address - Phone:512-287-9473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-22-60577103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst