MEDICARE: DR. KIRA MARIE AUSTIN PH.D., 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	1-15-18509

General Provider Information

NPI Number	:	1275058372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRA MARIE AUSTIN PH.D., BCBA

Provider Business Mailing Address
First Line	:	11510 ROLLING BROOK RD
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-2031
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5408 CHAMBERLAYNE RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-2407
Country	:	US
Telephone Number	:	855-444-9838
Fax Number	:

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

Provider Enumeration Date	:	08/09/2017
Last Update Date	:	08/09/2017

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