Provider Demographics
NPI:1295390714
Name:THEVERAPPERUMA, SAMANTHA (BCABA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:THEVERAPPERUMA
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5621 TIDEWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23509-1497
Mailing Address - Country:US
Mailing Address - Phone:757-351-4244
Mailing Address - Fax:
Practice Address - Street 1:5621 TIDEWATER DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23509-1497
Practice Address - Country:US
Practice Address - Phone:757-351-4244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst