Healthcare Provider Details

I. General information

NPI: 1356805139
Provider Name (Legal Business Name): WITHIN ME THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7375 EXECUTIVE PL STE 203
LANHAM MD
20706-6236
US

IV. Provider business mailing address

7375 EXECUTIVE PL STE 203
LANHAM MD
20706-6236
US

V. Phone/Fax

Practice location:
  • Phone: 301-970-9678
  • Fax:
Mailing address:
  • Phone: 301-970-9678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. LETICIA MORENO
Title or Position: BOARD CERTIFIED BEHAVIOR ANALYST
Credential: M.A. ED, BCBA
Phone: 914-494-3187