Provider Demographics
NPI:1215506910
Name:CESARD, SANDRA LYNN (BCBA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:CESARD
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LYNN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18148 MILL HOUSE SQ
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6872
Mailing Address - Country:US
Mailing Address - Phone:703-801-5606
Mailing Address - Fax:
Practice Address - Street 1:18148 MILL HOUSE SQ
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6872
Practice Address - Country:US
Practice Address - Phone:703-801-5606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133002019103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-21-48239OtherBEHAVIOR ANALYST CERTIFICATION BOARD
VA0133002019OtherVIRGINIA DEPARTMENT OF HEALTH PROFESSIONS