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NPI Code Detail

MEDICARE: DAMIJTA WING M.A., BCBA

MEDICARE: DAMIJTA WING M.A., 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
1222Q00000XDevelopmental Therapist
2103K00000XBehavior Analyst1-22-57491DE

General Provider Information

NPI Number : 1073069639
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAMIJTA WING M.A., BCBA
Provider Business Mailing Address
First Line : 510 PHILADELPHIA PIKE
Second Line :
City : WILMINGTON
State : DE
Zip : 19809-2100
Country : US
Telephone Number : 302-327-9215
Fax Number :
Provider Business Practice Location Address
First Line : 510 PHILADELPHIA PIKE
Second Line :
City : WILMINGTON
State : DE
Zip : 19809-2100
Country : US
Telephone Number : 302-327-9215
Fax Number : 302-348-9028
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2016
Last Update Date : 03/17/2022

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