Provider Demographics
NPI:1265100960
Name:HERTEL, MARIANA ROSE (MED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:ROSE
Last Name:HERTEL
Suffix:
Gender:
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 PARK TOWER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-7342
Mailing Address - Country:US
Mailing Address - Phone:703-533-3131
Mailing Address - Fax:
Practice Address - Street 1:2600 PARK TOWER DR STE 200
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-7342
Practice Address - Country:US
Practice Address - Phone:703-533-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133004096103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst