Provider Demographics
NPI:1265948830
Name:SURACI, ANGELA MARY (BCBA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARY
Last Name:SURACI
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 1:2 VILLAGE SQ STE 210
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1624
Mailing Address - Country:US
Mailing Address - Phone:866-565-7222
Mailing Address - Fax:877-734-1914
Practice Address - Street 1:14059 CROWN CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1458
Practice Address - Country:US
Practice Address - Phone:866-565-7222
Practice Address - Fax:877-734-1914
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-19-40344103K00000X
VA0133001634103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst