Provider Demographics
NPI:1871876094
Name:HAUPT, ROBERT ADAM (MS, BCBA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ADAM
Last Name:HAUPT
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6059 BRISTOL PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6673
Mailing Address - Country:US
Mailing Address - Phone:310-641-1100
Mailing Address - Fax:310-641-1174
Practice Address - Street 1:6059 BRISTOL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6673
Practice Address - Country:US
Practice Address - Phone:310-641-1100
Practice Address - Fax:310-641-1174
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1073540103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst