Provider Demographics
NPI:1164981908
Name:WOOLF, ALICIA (BCBA)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:WOOLF
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 HANNES ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1720
Mailing Address - Country:US
Mailing Address - Phone:203-233-8994
Mailing Address - Fax:
Practice Address - Street 1:1777 REISTERSTOWN RD STE 236
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-1343
Practice Address - Country:US
Practice Address - Phone:410-205-2315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA586103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst