Active NPI
Clifford J Blanc
- Behavior Technician
- MC Lean, VA
National Provider Identifier
1114410123
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-18-56593
- Practice address
- 1651 Old Meadow Rd Ste 600
MC Lean, VA 22102-4389 - Phone
- (703) 564-1662
- NPI assigned
- Jun 13, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-18-56593 | VA | Primary |
Addresses
Primary practice location
1651 Old Meadow Rd Ste 600
MC Lean, VA 22102-4389
Mailing address
40 S Van Dorn St Apt D215
Alexandria, VA 22304-4214
Phone (508) 818-1970
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-18-56593 | VA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528848000000",
"number": "1114410123",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 S VAN DORN ST APT D215",
"city": "ALEXANDRIA",
"state": "VA",
"postal_code": "223044214",
"telephone_number": "508-818-1970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1651 OLD MEADOW RD STE 600",
"city": "MC LEAN",
"state": "VA",
"postal_code": "221024389",
"telephone_number": "703-564-1662"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLANC",
"first_name": "CLIFFORD",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-13",
"last_updated": "2018-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "VA",
"license": "RBT-18-56593",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in MC Lean, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.