MEDICARE: BETHANY RADCLIFFE 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	0133000422	VA
2	103K00000X	Behavior Analyst	LBA067	MD

General Provider Information

NPI Number	:	1932510245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY RADCLIFFE BCBA

Provider Business Mailing Address
First Line	:	1320 N VEITCH ST
Second Line	:	# 1222
City	:	ARLINGTON
State	:	VA
Zip	:	22201-6221
Country	:	US
Telephone Number	:	724-288-8157
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 N VEITCH ST
Second Line	:	# 1222
City	:	ARLINGTON
State	:	VA
Zip	:	22201-6221
Country	:	US
Telephone Number	:	724-288-8157
Fax Number	:

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

Provider Enumeration Date	:	05/09/2014
Last Update Date	:	06/25/2015

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Directions to “ BETHANY RADCLIFFE BCBA” Practice Location

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