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NPI Code Detail

MEDICARE: FAYE VICTORIA GAZABAT BCBA, LBA

MEDICARE: FAYE VICTORIA GAZABAT 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 AnalystBA61370580WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1BA61370580OTHERWASTATE LICENSE

General Provider Information

NPI Number : 1932755824
Entity Type Code : Individual
Provider Name (Legal Business Name) : FAYE VICTORIA GAZABAT BCBA, LBA
Provider Business Mailing Address
First Line : 9711 CRESCENT VALLEY DR NW
Second Line :
City : GIG HARBOR
State : WA
Zip : 98332-7555
Country : US
Telephone Number : 817-454-2841
Fax Number :
Provider Business Practice Location Address
First Line : 13765 VINTAGE DR SW
Second Line :
City : PORT ORCHARD
State : WA
Zip : 98367-7391
Country : US
Telephone Number : 253-970-2414
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2019
Last Update Date : 02/20/2025

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