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General NPI Number Information
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NPI Number | 1265145551
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Entity Type | Individual
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Provider Name | SERENA MARY BURGESS MS,QMHP, QASP-S, RBT
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Gender | Female
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Dates
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Enumeration Date | 01/02/2023
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 8405 RICHMOND HWY STE E
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City | ALEXANDRIA
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State | VA
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Zip | 22309-2425
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Country | US
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Telephone | 703-595-5664
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Fax | 571-503-9992
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Provider Business Mailing Address
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Address Line | 2804 CAPRI DR
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City | FORT WASHINGTON
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State | MD
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Zip | 20744-2211
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Country | US
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Telephone | 707-208-6435
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-20-146508
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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