Provider Demographics
NPI:1447527148
Name:NEWCOMB, ELI T (MED, BCBA)
Entity type:Individual
Prefix:MR
First Name:ELI
Middle Name:T
Last Name:NEWCOMB
Suffix:
Gender:M
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 BYRD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3011
Mailing Address - Country:US
Mailing Address - Phone:804-612-1947
Mailing Address - Fax:804-612-1955
Practice Address - Street 1:1701 BYRD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3011
Practice Address - Country:US
Practice Address - Phone:804-612-1947
Practice Address - Fax:804-612-1955
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-11-8690103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst