Healthcare Provider Details

I. General information

NPI: 1861159121
Provider Name (Legal Business Name): ROBERT AUSTIN-VILLANUEVA III BCABA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 BROOK RD
RICHMOND VA
23227-1338
US

IV. Provider business mailing address

2820 WATERFORD LAKE DR STE 102
MIDLOTHIAN VA
23112-3994
US

V. Phone/Fax

Practice location:
  • Phone: 804-521-5579
  • Fax: 804-553-3310
Mailing address:
  • Phone: 804-658-4509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-21-13178
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-161513
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133004029
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: