Provider Demographics
NPI:1578267183
Name:TRIGSTED, MARY (MA, BCBA)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:
Last Name:TRIGSTED
Suffix:
Gender:F
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 1:2700 DORR AVE APT 1023
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4957
Mailing Address - Country:US
Mailing Address - Phone:847-707-2802
Mailing Address - Fax:
Practice Address - Street 1:131 ELDEN ST STE 302
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4851
Practice Address - Country:US
Practice Address - Phone:703-496-4371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst