Provider Demographics
NPI:1447582507
Name:MITTERMAIER, DAVID (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MITTERMAIER
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 16TH ST NW
Mailing Address - Street 2:APT 619
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-6502
Mailing Address - Country:US
Mailing Address - Phone:201-841-5096
Mailing Address - Fax:
Practice Address - Street 1:2101 16TH ST NW
Practice Address - Street 2:APT 619
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-6502
Practice Address - Country:US
Practice Address - Phone:201-841-5096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1-09-6355103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst