Healthcare Provider Details

I. General information

NPI: 1063316339
Provider Name (Legal Business Name): TAYLOR BURKE VAN DERVORT BCBA,LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 METAIRIE RD STE 515
METAIRIE LA
70005-4326
US

IV. Provider business mailing address

406 SENA DR
METAIRIE LA
70005-2706
US

V. Phone/Fax

Practice location:
  • Phone: 504-833-6730
  • Fax:
Mailing address:
  • Phone: 404-398-7860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberL-1168
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: