Provider Demographics
NPI:1285913160
Name:DWYER-ALLEN, JULIE CREGAN (BCBA)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:CREGAN
Last Name:DWYER-ALLEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:CREGAN
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:142 HAMPSHIRE SQ SW
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-5059
Mailing Address - Country:US
Mailing Address - Phone:703-678-7349
Mailing Address - Fax:
Practice Address - Street 1:142 HAMPSHIRE SQ SW
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-5059
Practice Address - Country:US
Practice Address - Phone:703-678-7349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000376103K00000X
1-05-2617103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst