Provider Demographics
NPI:1891050720
Name:KELLY, ANDREA ISABEL (BCBA)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:ISABEL
Last Name:KELLY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11240 WAPLES MILL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6078
Mailing Address - Country:US
Mailing Address - Phone:703-237-2219
Mailing Address - Fax:703-237-2729
Practice Address - Street 1:11240 WAPLES MILL ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-237-2219
Practice Address - Fax:703-237-2729
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11211911103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst