MEDICARE: ANTANISHA KAUFFMAN

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	106S00000X	Behavior Technician	RBT-21-165773	VA

General Provider Information

NPI Number	:	1154904159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTANISHA KAUFFMAN

Provider Business Mailing Address
First Line	:	6400 ARLINGTON BLVD STE 670
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-2336
Country	:	US
Telephone Number	:	703-864-1992
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 ARLINGTON BLVD STE 670
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-2336
Country	:	US
Telephone Number	:	703-992-6938
Fax Number	:

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

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	03/03/2026

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