Healthcare Provider Details

I. General information

NPI: 1912699158
Provider Name (Legal Business Name): KASEY LEE ISLAM M.ED., BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2308 STARFISH RD APT 101
VIRGINIA BEACH VA
23451-1241
US

IV. Provider business mailing address

2308 STARFISH RD APT 101
VIRGINIA BEACH VA
23451-1241
US

V. Phone/Fax

Practice location:
  • Phone: 757-375-5069
  • Fax:
Mailing address:
  • Phone: 757-375-5069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133004646
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: