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General NPI Number Information
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NPI Number | 1619518990
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Entity Type | Individual
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Provider Name | PAMELA LYN REZA BCBA, LBA
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Gender | Female
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Dates
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Enumeration Date | 10/08/2019
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 1108 EDEN WAY N STE E
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3339
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Country | US
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Telephone | 703-596-9332
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Fax | 540-744-1091
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Provider Business Mailing Address
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Address Line | 18025 GRAND PROSPERITY DR
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City | VENICE
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State | FL
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Zip | 34293-4966
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Country | US
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Telephone | 703-596-2237
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Fax | 540-744-1091
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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 | 0133001513
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License Number State | VA
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