Healthcare Provider Details

I. General information

NPI: 1497340434
Provider Name (Legal Business Name): OLIVIA JEAN THOMPSON MASPED, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 11/20/2024
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 MIDLANDS RD
WILLIAMSBURG VA
23188-2575
US

IV. Provider business mailing address

8616 2ND AVE APT 142
SILVER SPRING MD
20910
US

V. Phone/Fax

Practice location:
  • Phone: 757-585-3216
  • Fax: 757-561-2541
Mailing address:
  • Phone: 757-585-3216
  • Fax: 757-561-2541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-147001
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-75611
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: