Healthcare Provider Details

I. General information

NPI: 1841898277
Provider Name (Legal Business Name): VICTORIA ISABEL ROSE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA ISABEL MIRO RBT

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 10/26/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11824 FISHING POINT DR STE B
NEWPORT NEWS VA
23606-2679
US

IV. Provider business mailing address

2 MACIRVIN DR
NEWPORT NEWS VA
23606-2123
US

V. Phone/Fax

Practice location:
  • Phone: 888-311-2496
  • Fax:
Mailing address:
  • Phone: 571-251-7791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-69059
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-139917
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: