MEDICARE: KAROLINA KUTYLO MITRAJ MS, BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	0133002319	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0133002319	OTHER	VA	VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS

General Provider Information

NPI Number	:	1073067641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAROLINA KUTYLO MITRAJ MS, BCBA

Provider Business Mailing Address
First Line	:	131 ELDEN ST STE 302
Second Line	:
City	:	HERNDON
State	:	VA
Zip	:	20170-4851
Country	:	US
Telephone Number	:	812-610-9039
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 PARAGON PL STE 200
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-1652
Country	:	US
Telephone Number	:	804-562-9997
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2016
Last Update Date	:	11/07/2025

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