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NPI Code Detail

MEDICARE: SERENA MARY BURGESS MS,QMHP, QASP-S, RBT

MEDICARE: SERENA MARY BURGESS MS,QMHP, QASP-S, 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
1106S00000XBehavior TechnicianRBT-20-146508VA
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1265145551
Entity Type Code : Individual
Provider Name (Legal Business Name) : SERENA MARY BURGESS MS,QMHP, QASP-S, RBT
Provider Business Mailing Address
First Line : 2804 CAPRI DR
Second Line :
City : FORT WASHINGTON
State : MD
Zip : 20744-2211
Country : US
Telephone Number : 707-208-6435
Fax Number :
Provider Business Practice Location Address
First Line : 8405 RICHMOND HWY STE E
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22309-2425
Country : US
Telephone Number : 703-595-5664
Fax Number : 571-503-9992
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2023
Last Update Date : 12/19/2024

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