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General NPI Number Information
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NPI Number | 1245245604
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Entity Type | Organization
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Legal Business Name | POSITIVE BEHAVIORAL DYNAMICS, LLC
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 150 LITTLE FALLS ST SUITE 101
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4315
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Country | US
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Telephone | 703-533-3856
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Fax | 703-533-3857
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Provider Business Mailing Address
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Address Line | 150 LITTLE FALLS ST SUITE 101
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4315
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Country | US
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Telephone | 703-533-3856
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Fax | 703-533-3857
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Authorized Official
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Title or Position | DIRECTOR OF CONSULTATIVE SERVICES
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Name | DR. BENJAMIN C. MAURO
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Credential | PHD
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Telephone | 703-533-3856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0811000970
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License Number State | VA
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