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NPI Code Detail

MEDICARE: BLUE GEMS ABA THERAPY VA LLC

MEDICARE: BLUE GEMS ABA THERAPY VA 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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1659180826
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUE GEMS ABA THERAPY VA LLC
Provider Business Mailing Address
First Line : 8280 WILLOW OAKS CORPORATE DR STE 600
Second Line :
City : FAIRFAX
State : VA
Zip : 22031-4516
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8280 WILLOW OAKS CORPORATE DR STE 600
Second Line :
City : FAIRFAX
State : VA
Zip : 22031-4516
Country : US
Telephone Number : 571-370-4734
Fax Number :
Authorized Official
Title or Position : CEO
Name : DAVID WOLF
Credential :
Telephone Number : 617-297-7998
Provider Enumeration Date : 01/02/2025
Last Update Date : 06/01/2026

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Directions to “BLUE GEMS ABA THERAPY VA LLC ” Practice Location

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