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NPI Code Detail

MEDICARE: ELIZABETH DEVITA

MEDICARE: ELIZABETH DEVITA
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1386246361
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH DEVITA
Provider Business Mailing Address
First Line : 9351 W BROAD ST
Second Line :
City : HENRICO
State : VA
Zip : 23294-5437
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1822 SPRING GARDEN ST SIDE 2
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19130-4138
Country : US
Telephone Number : 484-444-2285
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2020
Last Update Date : 08/16/2021

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