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NPI Code Detail

MEDICARE: AUTUMN A KEENER M.ED., BCBA, LBA

MEDICARE: AUTUMN A KEENER M.ED., BCBA, LBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst0133000517VA

General Provider Information

NPI Number : 1154729788
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUTUMN A KEENER M.ED., BCBA, LBA
Provider Business Mailing Address
First Line : 9351 W BROAD ST
Second Line :
City : HENRICO
State : VA
Zip : 23294-5437
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9351 W BROAD ST
Second Line :
City : HENRICO
State : VA
Zip : 23294-5437
Country : US
Telephone Number : 804-596-3275
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2014
Last Update Date : 09/07/2017

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