Provider Demographics
NPI:1134924558
Name:KHATOON, ASRA (RBT)
Entity type:Individual
Prefix:MS
First Name:ASRA
Middle Name:
Last Name:KHATOON
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3139 PINE ORCHARD LN APT 401
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-4269
Mailing Address - Country:US
Mailing Address - Phone:630-788-4342
Mailing Address - Fax:
Practice Address - Street 1:3139 PINE ORCHARD LN APT 401
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-4269
Practice Address - Country:US
Practice Address - Phone:630-788-4342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-25-413006106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician