Provider Demographics
NPI:1093207433
Name:OZZ, BROOKE KIEFFER (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:KIEFFER
Last Name:OZZ
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 BYRD ST
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24504-2113
Mailing Address - Country:US
Mailing Address - Phone:434-444-4608
Mailing Address - Fax:
Practice Address - Street 1:4108 E PARHAM RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-2754
Practice Address - Country:US
Practice Address - Phone:804-355-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000540103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty