Individual
MARYAM OMIDITABAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4528 PLANK RD, FREDERICKSBRG, VA 22407-0141
(540) 755-2937
Mailing address
4959 LINSEY CT, WOODBRIDGE, VA 22193-4327
(703) 296-7753
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0133003073
VA
Other
Enumeration date
06/23/2023
Last updated
06/23/2023
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