Active NPI
Dominique Anderson
- Behavior Analyst
- Bowie, MD
National Provider Identifier
1679172225
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- LBA-1962
- Practice address
- 6911 Laurel Bowie Rd
Bowie, MD 20715-1712 - Phone
- (301) 755-4021
- NPI assigned
- Oct 23, 2020
- Sex
- Female
- 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 Analyst | 103K00000X | LBA-1962 | MD | Primary |
Addresses
Primary practice location
6911 Laurel Bowie Rd
Bowie, MD 20715-1712
Mailing address
7529 Standish PL Ste 355
Derwood, MD 20855-2733
Phone (301) 444-5001
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 |
|---|---|---|---|
| LBA-1962 | MD | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728950400000",
"number": "1679172225",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7529 STANDISH PL STE 355",
"city": "DERWOOD",
"state": "MD",
"postal_code": "208552733",
"telephone_number": "301-444-5001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6911 LAUREL BOWIE RD",
"city": "BOWIE",
"state": "MD",
"postal_code": "207151712",
"telephone_number": "301-755-4021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "DOMINIQUE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-23",
"last_updated": "2024-10-15",
"certification_date": "2024-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MD",
"license": "LBA-1962",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bowie, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.