Healthcare Provider Details

I. General information

NPI: 1861199085
Provider Name (Legal Business Name): LYNA MOINIFAR MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7108 S KANNER HWY
STUART FL
34997-7462
US

IV. Provider business mailing address

20812 WALLINGFORD SQ APT 302
STERLING VA
20165-7385
US

V. Phone/Fax

Practice location:
  • Phone: 722-349-6317
  • Fax:
Mailing address:
  • Phone: 703-826-6016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-17199
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: