MEDICARE: GABRIELA CRISPINO RBT

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1205578028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELA CRISPINO RBT

Provider Business Mailing Address
First Line	:	1960 SANDEE CRES
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2308
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	429 CAROLINA AVE
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-4604
Country	:	US
Telephone Number	:	757-685-1384
Fax Number	:	757-210-4103

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

Provider Enumeration Date	:	04/12/2022
Last Update Date	:	04/12/2022

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Directions to “ GABRIELA CRISPINO RBT” Practice Location

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