MEDICARE: MALEK TESFAMARIAM BCABA

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-21-185534	VA
2	106E00000X	Assistant Behavior Analyst	01340000618	VA

General Provider Information

NPI Number	:	1255003976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALEK TESFAMARIAM BCABA

Provider Business Mailing Address
First Line	:	4668 PEMBROKE BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6423
Country	:	US
Telephone Number	:	757-770-9590
Fax Number	:

Provider Business Practice Location Address
First Line	:	1968 EDNA WAY
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-1794
Country	:	US
Telephone Number	:	757-770-9590
Fax Number	:

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

Provider Enumeration Date	:	09/30/2021
Last Update Date	:	06/17/2025

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