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NPI Code Detail

MEDICARE: AMES BENJAMIN CLARK BCBA, LBA

MEDICARE: AMES BENJAMIN CLARK 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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst
3103K00000XBehavior Analyst0133002337VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710480215
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMES BENJAMIN CLARK BCBA, LBA
Provider Business Mailing Address
First Line : 3433 BRAMBLETON AVE
Second Line :
City : ROANOKE
State : VA
Zip : 24018-6515
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3433 BRAMBLETON AVE STE 201A
Second Line :
City : ROANOKE
State : VA
Zip : 24018-6527
Country : US
Telephone Number : 540-266-7550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2018
Last Update Date : 03/14/2024

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