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General NPI Number Information
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NPI Number | 1255883245
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Entity Type | Individual
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Provider Name | KATHARINE DECOSSAUX BCBA, LBA
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Gender | Female
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Dates
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Enumeration Date | 10/26/2016
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 2000 TOWER OAKS BLVD FL 5
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City | ROCKVILLE
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State | MD
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Zip | 20852-4282
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Country | US
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Telephone | 301-444-5001
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Fax |
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Provider Business Mailing Address
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Address Line | 1126 CAMAS AVE NW
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City | PALM BAY
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State | FL
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Zip | 32907-9464
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-20-42685
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License Number State | FL
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