Healthcare Provider Details

I. General information

NPI: 1194155895
Provider Name (Legal Business Name): VICTORIA MARIN MA, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E PRATT ST
BALTIMORE MD
21202-3116
US

IV. Provider business mailing address

19902 BUHRSTONE DR
GAITHERSBURG MD
20886-1017
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax: 772-675-9100
Mailing address:
  • Phone: 786-328-8949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-15-6435
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-53522
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: