Provider Demographics
NPI:1619448206
Name:DZYAK, ANNALISE GIORGIANNI (BCBA, LBA)
Entity Type:Individual
Prefix:MISS
First Name:ANNALISE
Middle Name:GIORGIANNI
Last Name:DZYAK
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 BURKE WOODS DR
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3932
Mailing Address - Country:US
Mailing Address - Phone:703-462-3065
Mailing Address - Fax:
Practice Address - Street 1:6216 OLD KEENE MILL CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-2323
Practice Address - Country:US
Practice Address - Phone:703-462-3065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-08
Last Update Date:2018-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001262103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst