Provider Demographics
NPI:1497026942
Name:TOWNSEND, PETAGAYE SIMONE (MS, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:PETAGAYE
Middle Name:SIMONE
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8480 BALTIMORE NATIONAL PIKE STE 3210 #126
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-1420
Mailing Address - Country:US
Mailing Address - Phone:914-363-8313
Mailing Address - Fax:
Practice Address - Street 1:8480 BALTIMORE NATIONAL PIKE STE 3210 #126
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043
Practice Address - Country:US
Practice Address - Phone:914-363-8313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-14
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1125719222Q00000X
NY1-14-9454103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist