Provider Demographics
NPI:1669187423
Name:REYES, ELIZA MARIE (BCABA)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:MARIE
Last Name:REYES
Suffix:
Gender:F
Credentials:BCABA
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 1:4141 N HENDERSON RD STE 8
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-2485
Practice Address - Country:US
Practice Address - Phone:571-777-9210
Practice Address - Fax:877-734-1914
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000398106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0-21-12620OtherBACB CERTIFICATION NUMBER