Provider Demographics
NPI:1790162634
Name:MURTAGH, DAMIEN (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:DAMIEN
Middle Name:
Last Name:MURTAGH
Suffix:
Gender:M
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 1:312 WHITWELL DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-2039
Mailing Address - Country:US
Mailing Address - Phone:540-366-7399
Mailing Address - Fax:
Practice Address - Street 1:20261 LYNCHBURG HWY
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-3978
Practice Address - Country:US
Practice Address - Phone:434-525-4790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA133000046103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst