Healthcare Provider Details

I. General information

NPI: 1508785023
Provider Name (Legal Business Name): CHIAGOZIEM JOSIAH NWABUGWU RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6814 BEACON PL
RIVERDALE MD
20737-1702
US

IV. Provider business mailing address

6814 BEACON PL
RIVERDALE MD
20737-1702
US

V. Phone/Fax

Practice location:
  • Phone: 240-970-0105
  • Fax:
Mailing address:
  • Phone: 240-970-0105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-545877
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: