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NPI Code Detail

MEDICARE: KATLYN ELIZABETH BAINES BCBA, LBA

MEDICARE: KATLYN ELIZABETH BAINES BCBA, LBA
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 Analyst0133004044VA

General Provider Information

NPI Number : 1356987853
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATLYN ELIZABETH BAINES BCBA, LBA
Provider Business Mailing Address
First Line : 4417 CORPORATION LN STE 300
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23462-3477
Country : US
Telephone Number : 757-785-3338
Fax Number : 855-847-6797
Provider Business Practice Location Address
First Line : 4417 CORPORATION LN STE 300
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23462-3477
Country : US
Telephone Number : 757-785-3338
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2019
Last Update Date : 01/02/2025

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