Provider Demographics
NPI:1063900389
Name:LITONJUA, KERRY ANN O'SHEA (BCBA, MED)
Entity type:Individual
Prefix:MRS
First Name:KERRY ANN
Middle Name:O'SHEA
Last Name:LITONJUA
Suffix:
Gender:F
Credentials:BCBA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8049 FAIRFAX RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22308-1408
Mailing Address - Country:US
Mailing Address - Phone:703-212-0527
Mailing Address - Fax:
Practice Address - Street 1:8049 FAIRFAX RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22308-1408
Practice Address - Country:US
Practice Address - Phone:703-212-0527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000627103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst