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NPI Code Detail

MEDICARE: CLEMENTINE VIRGINIA ABA LLC

MEDICARE: CLEMENTINE VIRGINIA ABA 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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1285582247
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLEMENTINE VIRGINIA ABA LLC
Provider Business Mailing Address
First Line : 1545 CROSSWAYS BLVD STE 250
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23320-0218
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1545 CROSSWAYS BLVD STE 250
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23320-0218
Country : US
Telephone Number : 888-603-2536
Fax Number :
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : AHARON GERSON
Credential :
Telephone Number : 516-510-5074
Provider Enumeration Date : 03/17/2026
Last Update Date : 03/17/2026

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Directions to “CLEMENTINE VIRGINIA ABA LLC ” Practice Location

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