Provider Demographics
NPI:1144562380
Name:TALIAFERRO, ANDREA (MS)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:TALIAFERRO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:RIEBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6532 WALLASEY CT
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-5408
Mailing Address - Country:US
Mailing Address - Phone:256-239-8030
Mailing Address - Fax:
Practice Address - Street 1:10686 CRESTWOOD DR
Practice Address - Street 2:SUITES A & B
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-4407
Practice Address - Country:US
Practice Address - Phone:703-392-6166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000234103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-10-7030OtherBEHAVIOR ANALYSIS CERTIFICATION BOARD