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General NPI Number Information
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NPI Number | 1700446945
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Entity Type | Individual
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Provider Name | MADHUMATHI ANNAMRAJU BCBA
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Gender | Female
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Dates
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Enumeration Date | 06/19/2019
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 11824 FISHING POINT DR STE B
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-2679
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Country | US
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Telephone | 804-683-5194
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Fax |
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Provider Business Mailing Address
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Address Line | 24190 LENAH WOODS PL
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City | ALDIE
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State | VA
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Zip | 20105-2369
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Country | US
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Telephone | 516-508-6661
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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 | 0133001429
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License Number State | VA
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