Provider Demographics
NPI:1891440087
Name:KABRAN, AMAH CHAMBENY
Entity Type:Individual
Prefix:
First Name:AMAH
Middle Name:CHAMBENY
Last Name:KABRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHAMBENY
Other - Middle Name:
Other - Last Name:KABRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:435 CARLISLE DR STE B
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:435 CARLISLE DR STE B
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5614
Practice Address - Country:US
Practice Address - Phone:703-987-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician