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General NPI Number Information
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NPI Number | 1578982765
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Entity Type | Individual
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Provider Name | JONATHAN R CHWIRUT BCABA
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Gender | Male
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 02/19/2021
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Provider Practice Location Address
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Address Line | 7000 OAK FOREST LN
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City | BETHESDA
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State | MD
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Zip | 20817-2124
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Country | US
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Telephone | 240-672-2386
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Fax | 443-221-4486
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Provider Business Mailing Address
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Address Line | 156 ALEXANDRIA PIKE
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City | WARRENTON
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State | VA
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Zip | 20186-2810
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Country | US
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Telephone | 703-496-4371
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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 | 0-14-5875
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License Number State | MD
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