MEDICARE: GERRON COOPER BCBA

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
1	103K00000X	Behavior Analyst	0133001793	VA

General Provider Information

NPI Number	:	1164022661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERRON COOPER BCBA

Provider Business Mailing Address
First Line	:	1575 ANDERSON RD APT 1306
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-1633
Country	:	US
Telephone Number	:	703-541-8080
Fax Number	:

Provider Business Practice Location Address
First Line	:	3814 12TH ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20017-2630
Country	:	US
Telephone Number	:	202-469-4031
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2020
Last Update Date	:	02/13/2026

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Directions to “ GERRON COOPER BCBA” Practice Location

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