Provider Demographics
NPI:1457941882
Name:MALTS, LARISA A (RBT)
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:A
Last Name:MALTS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 S PATRICK ST APT 4
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4039
Mailing Address - Country:US
Mailing Address - Phone:571-225-6900
Mailing Address - Fax:
Practice Address - Street 1:6400 ARLINGTON BLVD STE 670
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-2336
Practice Address - Country:US
Practice Address - Phone:703-992-6938
Practice Address - Fax:866-499-8840
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-20-121531106S00000X
VA0133002821103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician