Provider Demographics
NPI:1619518990
Name:REZA, PAMELA LYN (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYN
Last Name:REZA
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 1:18025 GRAND PROSPERITY DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-4966
Mailing Address - Country:US
Mailing Address - Phone:703-596-2237
Mailing Address - Fax:540-744-1091
Practice Address - Street 1:1108 EDEN WAY N STE E
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3339
Practice Address - Country:US
Practice Address - Phone:703-596-9332
Practice Address - Fax:540-744-1091
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001513103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst