Healthcare Provider Details

I. General information

NPI: 1780114785
Provider Name (Legal Business Name): MADISON PAIGE BUCZYNSKI BENJAMIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 TOWER OAKS BLVD
ROCKVILLE MD
20852-4282
US

IV. Provider business mailing address

2000 TOWER OAKS BLVD
ROCKVILLE MD
20852-4282
US

V. Phone/Fax

Practice location:
  • Phone: 301-514-4514
  • Fax:
Mailing address:
  • Phone: 301-514-4514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-59871
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: