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NPI Code Detail

MEDICARE: MR. DUSTIN MARTIN ISRAEL BCBA, LBA

MEDICARE: MR. DUSTIN MARTIN ISRAEL 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 Analyst0133001160VA

General Provider Information

NPI Number : 1609362383
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DUSTIN MARTIN ISRAEL BCBA, LBA
Provider Business Mailing Address
First Line : 1138 2ND ST SW
Second Line :
City : ROANOKE
State : VA
Zip : 24016-4725
Country : US
Telephone Number : 540-312-3133
Fax Number :
Provider Business Practice Location Address
First Line : 1138 2ND ST SW
Second Line :
City : ROANOKE
State : VA
Zip : 24016-4725
Country : US
Telephone Number : 540-312-3133
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2018
Last Update Date : 05/15/2023

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