Healthcare Provider Details

I. General information

NPI: 1417612953
Provider Name (Legal Business Name): REBECCA ROSILLO BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2021
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 BAKER LN STE 4
WINCHESTER VA
22603-5757
US

IV. Provider business mailing address

410 SHAWNEE TRL
WINCHESTER VA
22602-1324
US

V. Phone/Fax

Practice location:
  • Phone: 877-498-0319
  • Fax:
Mailing address:
  • Phone: 540-664-9269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133003688
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: