Healthcare Provider Details

I. General information

NPI: 1710697362
Provider Name (Legal Business Name): CHIOMA NWABUZO RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date: 07/22/2026
Reactivation Date: 08/21/2026

III. Provider practice location address

6115 FALLS RD
BALTIMORE MD
21209-2219
US

IV. Provider business mailing address

6115 FALLS RD
BALTIMORE MD
21209-2219
US

V. Phone/Fax

Practice location:
  • Phone: 484-965-9966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA2761
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: