Provider Demographics
NPI:1871179895
Name:RASNICK, KAYLEIGH (BCABA)
Entity Type:Individual
Prefix:MRS
First Name:KAYLEIGH
Middle Name:
Last Name:RASNICK
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 PRINCESS ANNE ST STE 407
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5804
Mailing Address - Country:US
Mailing Address - Phone:540-479-3889
Mailing Address - Fax:540-479-3946
Practice Address - Street 1:312 PROGRESS ST STE 300
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3356
Practice Address - Country:US
Practice Address - Phone:540-479-3889
Practice Address - Fax:540-479-1605
Is Sole Proprietor?:No
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000363103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst