Provider Demographics
NPI:1073067641
Name:MITRAJ, KAROLINA KUTYLO (MS, BCBA)
Entity type:Individual
Prefix:
First Name:KAROLINA
Middle Name:KUTYLO
Last Name:MITRAJ
Suffix:
Gender:
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:KAROLINA
Other - Middle Name:
Other - Last Name:KUTYLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6800 PARAGON PL STE 200
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1652
Mailing Address - Country:US
Mailing Address - Phone:804-562-9997
Mailing Address - Fax:
Practice Address - Street 1:6800 PARAGON PL STE 200
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1652
Practice Address - Country:US
Practice Address - Phone:804-562-9997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133002319103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0133002319OtherVIRGINIA DEPARTMENT OF HEALTH PROFESSIONS