Individual provider Active NPI

Krystal Celeste Javier Samuel, BCBA, LBA

  • Behavior Analyst
  • Newport News, VA
National Provider Identifier
1194231639
Registry record updated Sep 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1-22-57726 Issued in VA
Practice address
739 Thimble Shoals Blvd Ste 302
Newport News, VA 23606-3562
Phone
(866) 565-7222
Fax
(877) 734-1914
NPI assigned
Dec 20, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 1-22-57726 VA Primary

Addresses

Primary practice location

739 Thimble Shoals Blvd Ste 302
Newport News, VA 23606-3562

Mailing address

2 Village SQ Ste 210
Baltimore, MD 21210-1624
Phone (609) 525-4271

Other identifiers 1

IdentifierTypeStateIssuer
1194231639MedicaidVA

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

Practice roles

OrganizationSpecialtyStatusNew patients
Krystal Javier Samuel, LLC Behavior Analyst Current Accepting new patients
Your Life ABA VA, LLC Behavior Analyst PastSince Sep 24, 2023 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1513728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695254400000",
    "number": "1194231639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 VILLAGE SQ STE 210",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212101624",
            "telephone_number": "609-525-4271",
            "fax_number": "443-743-3863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "739 THIMBLE SHOALS BLVD STE 302",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236063562",
            "telephone_number": "866-565-7222",
            "fax_number": "877-734-1914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAVIER SAMUEL",
        "first_name": "KRYSTAL",
        "middle_name": "CELESTE",
        "credential": "BCBA, LBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-20",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "VA",
            "license": "1-22-57726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194231639",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport News, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.