Provider Demographics
NPI:1437931383
Name:SKYWARD BEHAVIORAL HEALTH, PLLC
Entity Type:Organization
Organization Name:SKYWARD BEHAVIORAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DICOSTANZO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:804-972-5272
Mailing Address - Street 1:14367 ASHLAND RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-1602
Mailing Address - Country:US
Mailing Address - Phone:804-972-5272
Mailing Address - Fax:804-800-4787
Practice Address - Street 1:14367 ASHLAND RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-1602
Practice Address - Country:US
Practice Address - Phone:804-972-5272
Practice Address - Fax:804-800-4787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty