Healthcare Provider Details

I. General information

NPI: 1972870152
Provider Name (Legal Business Name): MODUPEH CLEEVE M.S., BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8549 CROOKED TREE LN
LAUREL MD
20724-2489
US

IV. Provider business mailing address

8549 CROOKED TREE LN
LAUREL MD
20724-2489
US

V. Phone/Fax

Practice location:
  • Phone: 301-526-5449
  • Fax:
Mailing address:
  • Phone: 301-526-5449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-9371
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: