Healthcare Provider Details

I. General information

NPI: 1831956069
Provider Name (Legal Business Name): CONNECT N CARE ABA VA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8609 WESTWOOD CENTER DR
TYSONS VA
22182-7521
US

IV. Provider business mailing address

1072 MADISON AVE STE 625
LAKEWOOD NJ
08701-2650
US

V. Phone/Fax

Practice location:
  • Phone: 877-262-2221
  • Fax: 877-745-4345
Mailing address:
  • Phone: 877-262-2221
  • Fax: 877-745-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: F ORZEL
Title or Position: CLINICAL DIRECTOR
Credential: BCBA
Phone: 704-412-1132