Provider Demographics
NPI:1629301023
Name:BRITWUM, MICHELLE L (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:BRITWUM
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:SNOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA, LBS
Mailing Address - Street 1:706 W PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4030
Mailing Address - Country:US
Mailing Address - Phone:301-882-7932
Mailing Address - Fax:301-500-2173
Practice Address - Street 1:706 W PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4030
Practice Address - Country:US
Practice Address - Phone:301-882-7932
Practice Address - Fax:301-500-2173
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA1203103K00000X
PABH000569103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1-14-10293OtherBEHAVIOR ANALYSIS CERTIFICATION BOARD (BACB)
MDLBA1203OtherLICENSED BEHAVIOR ANALYST