Healthcare Provider Details

I. General information

NPI: 1992276265
Provider Name (Legal Business Name): SAMANTHA S CAPUANO BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

293 INDEPENDENCE BLVD STE 400
VIRGINIA BEACH VA
23462-5461
US

IV. Provider business mailing address

725 DEER LAKE DR
VIRGINIA BEACH VA
23462-4763
US

V. Phone/Fax

Practice location:
  • Phone: 757-785-3338
  • Fax:
Mailing address:
  • Phone: 262-501-0357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133001958
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: