Provider Demographics
NPI:1306325329
Name:RODRIGUEZ, SHANA L (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:L
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 M ST SW # N602
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-4019
Mailing Address - Country:US
Mailing Address - Phone:321-438-6576
Mailing Address - Fax:
Practice Address - Street 1:300 M ST SW # N602
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-4019
Practice Address - Country:US
Practice Address - Phone:321-438-6576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA449103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty