MEDICARE: ANDREA DIVINE MITI-KAVUMA

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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1780518597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA DIVINE MITI-KAVUMA

Provider Business Mailing Address
First Line	:	PO BOX 360595
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15251-6595
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12210 PLUM ORCHARD DR STE 216
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-7911
Country	:	US
Telephone Number	:	718-215-5311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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Directions to “ ANDREA DIVINE MITI-KAVUMA ” Practice Location

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