Provider Demographics
NPI:1841898277
Name:ROSE, VICTORIA ISABEL (BCBA)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ISABEL
Last Name:ROSE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:ISABEL
Other - Last Name:MIRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:2 MACIRVIN DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2123
Mailing Address - Country:US
Mailing Address - Phone:571-251-7791
Mailing Address - Fax:
Practice Address - Street 1:11824 FISHING POINT DR STE B
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2679
Practice Address - Country:US
Practice Address - Phone:888-311-2496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-20-139917106S00000X
VA1-23-69059103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician