Provider Demographics
NPI:1609116516
Name:QUINN, KATHRYN (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:QUINN
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:GOGOEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, BCBA
Mailing Address - Street 1:6714 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-2318
Mailing Address - Country:US
Mailing Address - Phone:703-624-7526
Mailing Address - Fax:
Practice Address - Street 1:11814 SEVEN LOCKS RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20854-3395
Practice Address - Country:US
Practice Address - Phone:301-469-0223
Practice Address - Fax:301-469-0778
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-13-13338103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-13-13338OtherBEHAVIOR ANALYST CERTIFICATION BOARD