Provider Demographics
NPI:1821538307
Name:DANENBERGER, KAELA
Entity Type:Individual
Prefix:
First Name:KAELA
Middle Name:
Last Name:DANENBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2259 CRAMER LN
Mailing Address - Street 2:
Mailing Address - City:HAYES
Mailing Address - State:VA
Mailing Address - Zip Code:23072-4036
Mailing Address - Country:US
Mailing Address - Phone:757-581-7770
Mailing Address - Fax:
Practice Address - Street 1:118 RAILWAY RD
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-2930
Practice Address - Country:US
Practice Address - Phone:757-304-0224
Practice Address - Fax:757-852-0498
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2023-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
VA0134000473106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician