=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427729243
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HARLYN RODRIGUEZ POLANCO M.S.,BCBA,LBA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2021
-----------------------------------------------------
Last Update Date | 02/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7400 BEAUFONT SPRINGS DR STE 300
-----------------------------------------------------
City | NORTH CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23225-5519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-201-9082
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2929 GALLOWS RD STE 2A
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22042-1027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-435-8814
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 0133002030
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------