Provider Demographics
NPI:1407392061
Name:LARSON-MCGUIRE, BRANDON SCOTT (BCBA)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:SCOTT
Last Name:LARSON-MCGUIRE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6180 GROVEDALE CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2552
Mailing Address - Country:US
Mailing Address - Phone:866-380-3419
Mailing Address - Fax:
Practice Address - Street 1:6180 GROVEDALE CT
Practice Address - Street 2:SUITE 200
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2552
Practice Address - Country:US
Practice Address - Phone:866-380-3419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst