Provider Demographics
NPI:1700234382
Name:GRUETZMACHER, BECKY (MED, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:
Last Name:GRUETZMACHER
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20130 LAKEVIEW CENTER PLZ
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5904
Mailing Address - Country:US
Mailing Address - Phone:703-789-4662
Mailing Address - Fax:
Practice Address - Street 1:20130 LAKEVIEW CENTER PLZ
Practice Address - Street 2:SUITE 400
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5904
Practice Address - Country:US
Practice Address - Phone:703-789-4662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000741103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst