MEDICARE: BLUE ABA CENTER LLC

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

General Provider Information

NPI Number	:	1225971864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE ABA CENTER LLC

Provider Business Mailing Address
First Line	:	11977 GLEN ALDEN RD
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-6716
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11977 GLEN ALDEN RD
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-6716
Country	:	US
Telephone Number	:	571-234-2998
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROUSHAN BAGHERI
Credential	:
Telephone Number	:	571-234-2998

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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Directions to “BLUE ABA CENTER LLC ” Practice Location

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