Provider Demographics
NPI:1376998559
Name:FAY, BROOKE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:
Last Name:FAY
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 1:225 BURGESS LN
Mailing Address - Street 2:
Mailing Address - City:CLEAR BROOK
Mailing Address - State:VA
Mailing Address - Zip Code:22624-1690
Mailing Address - Country:US
Mailing Address - Phone:570-594-5651
Mailing Address - Fax:
Practice Address - Street 1:500 W JUBAL EARLY DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6507
Practice Address - Country:US
Practice Address - Phone:540-431-5651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000619103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst