Healthcare Provider Details

I. General information

NPI: 1982270468
Provider Name (Legal Business Name): TREVOR NEUBAUER BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 CORPORATION LN STE 245
VIRGINIA BEACH VA
23462-3676
US

IV. Provider business mailing address

4445 CORPORATION LN STE 245
VIRGINIA BEACH VA
23462-3676
US

V. Phone/Fax

Practice location:
  • Phone: 757-233-0003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-133007
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133002982
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: