MEDICARE: GINA HENRIQUES 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
1	103K00000X	Behavior Analyst	LBA2014	MD

General Provider Information

NPI Number	:	1801557095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA HENRIQUES BCBA

Provider Business Mailing Address
First Line	:	1534 CARSWELL ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-4903
Country	:	US
Telephone Number	:	718-600-1732
Fax Number	:

Provider Business Practice Location Address
First Line	:	1534 CARSWELL ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-4903
Country	:	US
Telephone Number	:	718-600-1732
Fax Number	:

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

Provider Enumeration Date	:	01/10/2022
Last Update Date	:	11/15/2024

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