Healthcare Provider Details

I. General information

NPI: 1265848451
Provider Name (Legal Business Name): EZRA HALL PH.D., BCBA-D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 WINCHESTER AVE
MARTINSBURG WV
25401-1683
US

IV. Provider business mailing address

PO BOX 442
SHEPHERDSTOWN WV
25443-0442
US

V. Phone/Fax

Practice location:
  • Phone: 304-290-4262
  • Fax: 304-212-0627
Mailing address:
  • Phone: 304-290-4262
  • Fax: 304-212-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: