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General NPI Number Information
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NPI Number | 1861159121
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Entity Type | Individual
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Provider Name | ROBERT AUSTIN-VILLANUEVA III BCABA
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Gender | Male
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Dates
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Enumeration Date | 11/22/2021
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 8000 BROOK RD
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City | RICHMOND
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State | VA
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Zip | 23227-1338
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Country | US
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Telephone | 804-521-5579
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Fax | 804-553-3310
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Provider Business Mailing Address
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Address Line | 2820 WATERFORD LAKE DR STE 102
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-3994
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Country | US
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Telephone | 804-658-4509
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 0-21-13178
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-21-161513
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 0133004029
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License Number State | VA
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