Provider Demographics
NPI:1932510245
Name:RADCLIFFE, BETHANY (BCBA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:RADCLIFFE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 N VEITCH ST
Mailing Address - Street 2:# 1222
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-6221
Mailing Address - Country:US
Mailing Address - Phone:724-288-8157
Mailing Address - Fax:
Practice Address - Street 1:1320 N VEITCH ST
Practice Address - Street 2:# 1222
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-6221
Practice Address - Country:US
Practice Address - Phone:724-288-8157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000422103K00000X
MDLBA067103K00000X
1-14-15719103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst