Healthcare Provider Details

I. General information

NPI: 1295412039
Provider Name (Legal Business Name): JACENTA GAYED BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 APOLLO DR STE 100
UPPER MARLBORO MD
20774-4785
US

IV. Provider business mailing address

131 ELDEN ST STE 302
HERNDON VA
20170-4851
US

V. Phone/Fax

Practice location:
  • Phone: 301-456-4787
  • Fax:
Mailing address:
  • Phone: 703-496-4371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133003104
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: