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NPI Code Detail

MEDICARE: MS. SHANNON MARIE KAZMERICK BCBA

MEDICARE: MS. SHANNON MARIE KAZMERICK 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 Analyst

General Provider Information

NPI Number : 1821403692
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHANNON MARIE KAZMERICK BCBA
Provider Business Mailing Address
First Line : 3452 25TH CT S
Second Line :
City : ARLINGTON
State : VA
Zip : 22206-2465
Country : US
Telephone Number : 570-793-7749
Fax Number :
Provider Business Practice Location Address
First Line : 1651 OLD MEADOW RD STE 600
Second Line :
City : MC LEAN
State : VA
Zip : 22102-4389
Country : US
Telephone Number : 703-506-0123
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2014
Last Update Date : 06/30/2014

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