Healthcare Provider Details

I. General information

NPI: 1235056318
Provider Name (Legal Business Name): LYNETTE M NEEDAM BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 SHIRLEY AVE
NORFOLK VA
23517-2109
US

IV. Provider business mailing address

5245 JOHNSTOWN LN
VIRGINIA BEACH VA
23464-6432
US

V. Phone/Fax

Practice location:
  • Phone: 571-582-1373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB1-23-66666
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: