Provider Demographics
NPI:1841956976
Name:ROMERO BENITEZ, LEDIN ROSIBEL (BCBA)
Entity type:Individual
Prefix:MRS
First Name:LEDIN ROSIBEL
Middle Name:
Last Name:ROMERO BENITEZ
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 1:1702 BEN FRANKLIN CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-7642
Mailing Address - Country:US
Mailing Address - Phone:571-707-0790
Mailing Address - Fax:757-561-2563
Practice Address - Street 1:8245 TAUNTON PL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-2428
Practice Address - Country:US
Practice Address - Phone:757-737-5456
Practice Address - Fax:757-561-2563
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-21-55301103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-21-55301OtherBACB
VA0133002290OtherVIRGINIA LBA