Provider Demographics
NPI:1447917570
Name:POOLE, NAOMI JACQUELINE GLADYS I (BT)
Entity type:Individual
Prefix:MISS
First Name:NAOMI
Middle Name:JACQUELINE GLADYS
Last Name:POOLE
Suffix:I
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20259 VENTURA BLVD STE 259A
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2551
Mailing Address - Country:US
Mailing Address - Phone:747-249-1127
Mailing Address - Fax:
Practice Address - Street 1:20259 VENTURA BLVD STE 259A
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2551
Practice Address - Country:US
Practice Address - Phone:747-249-1127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst