Healthcare Provider Details

I. General information

NPI: 1891332003
Provider Name (Legal Business Name): KATHY DICOSTANZO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14367 ASHLAND RD
GLEN ALLEN VA
23059-1602
US

IV. Provider business mailing address

14367 ASHLAND RD
GLEN ALLEN VA
23059-1602
US

V. Phone/Fax

Practice location:
  • Phone: 804-972-5272
  • Fax: 804-800-4787
Mailing address:
  • Phone: 804-972-5272
  • Fax: 804-800-4787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11936296
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: