Healthcare Provider Details

I. General information

NPI: 1679287015
Provider Name (Legal Business Name): BENNIES TOE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 SAMUEL MORSE DR STE 150
COLUMBIA MD
21046-3420
US

IV. Provider business mailing address

2000 TOWER OAKS BLVD STE 500
ROCKVILLE MD
20852-4377
US

V. Phone/Fax

Practice location:
  • Phone: 888-344-5977
  • Fax:
Mailing address:
  • Phone: 301-444-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133005052
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: