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NPI Code Detail

MEDICARE: CLANCEY RICHARDSON BCBA

MEDICARE: CLANCEY RICHARDSON 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
1103K00000XBehavior Analyst0133001171VA

General Provider Information

NPI Number : 1447665336
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLANCEY RICHARDSON BCBA
Provider Business Mailing Address
First Line : 500 FLINTLOCK RD
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23322-5481
Country : US
Telephone Number : 757-335-9775
Fax Number :
Provider Business Practice Location Address
First Line : 3101 MAGIC HOLLOW BLVD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23453-3010
Country : US
Telephone Number : 757-639-2218
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2014
Last Update Date : 01/05/2026

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