Individual
ETHAN KATZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.ED, BCBA, LBA
Contact information
Practice address
6563 EDSALL RD, SPRINGFIELD, VA 22151-4414
(703) 354-0000
Mailing address
3819 PRINCE WILLIAM DR, FAIRFAX, VA 22031-3820
(703) 346-3185
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-18-30640
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0133001179
VIRGINIA DEPARTMENT OF HEALTH PROFESSIONALS
VA
01
—
1-18-30640
BEHAVIOR ANALYST CERTIFICATION BOARD
—
Enumeration date
08/13/2018
Last updated
08/13/2018
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