Individual
MATILYN RENEE SOMMERFELDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5606B VIRGINIA BEACH BLVD STE 103, VIRGINIA BEACH, VA 23462-5680
(757) 216-9541
Mailing address
4300 BART ST, PORTSMOUTH, VA 23707-2854
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0-21-11955
VA
106S00000X
Behavior Technician
RBT-18-57466
—
Other
Enumeration date
01/05/2019
Last updated
07/21/2021
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