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NPI Code Detail

MEDICARE: TYNETTE CHANG BCBA

MEDICARE: TYNETTE CHANG 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 AnalystLBA317MD

General Provider Information

NPI Number : 1720120215
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYNETTE CHANG BCBA
Provider Business Mailing Address
First Line : PO BOX 237
Second Line :
City : PATUXENT RIVER
State : MD
Zip : 20670-0237
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5425 WISCONSIN AVE STE 600
Second Line :
City : CHEVY CHASE
State : MD
Zip : 20815-3588
Country : US
Telephone Number : 202-780-8976
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2007
Last Update Date : 10/26/2017

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