MEDICARE: BIANCA VASSARE PH.D.

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	103K00000X	Behavior Analyst	0133000976	VA

General Provider Information

NPI Number	:	1801312400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIANCA VASSARE PH.D.

Provider Business Mailing Address
First Line	:	5503 READING AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22311-2373
Country	:	US
Telephone Number	:	240-529-7259
Fax Number	:

Provider Business Practice Location Address
First Line	:	5503 READING AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22311-2373
Country	:	US
Telephone Number	:	240-529-7259
Fax Number	:

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

Provider Enumeration Date	:	08/16/2017
Last Update Date	:	11/05/2024

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