Provider Demographics
NPI:1023600343
Name:TAYLOR, SAMANTHA (BCBA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:TAYLOR
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 1:13411 FARMER DR
Mailing Address - Street 2:
Mailing Address - City:WOODFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22580-2815
Mailing Address - Country:US
Mailing Address - Phone:540-654-6229
Mailing Address - Fax:
Practice Address - Street 1:4201 BRIDLEPATH CT
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-8813
Practice Address - Country:US
Practice Address - Phone:540-847-1936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133004053103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
0Other0