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NPI Code Detail

MEDICARE: ANDRE PERRET BCBA, LBA

MEDICARE: ANDRE PERRET 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 Analyst

General Provider Information

NPI Number : 1750882296
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDRE PERRET BCBA, LBA
Provider Business Mailing Address
First Line : 312 MARSHALL AVE
Second Line :
City : LAUREL
State : MD
Zip : 20707-4824
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8200 PROFESSIONAL PL STE 115
Second Line :
City : LANDOVER
State : MD
Zip : 20785-2293
Country : US
Telephone Number : 240-297-3550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2018
Last Update Date : 08/02/2019

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