Staci Blair Marzolino, LCSW, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

0133000637 Issued in VA

Practice address

306 Westwood Office Park
Fredericksburg, VA 22401-5108

Phone

(856) 520-3099

NPI assigned

Mar 28, 2014

Last updated

Aug 5, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Supportive Care ABA VA LLC

  • Community/Behavioral Health Agency
  • McLean, VA
  • NPI 1053034231

  Behavior Analyst

  NPD (past)

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

{
    "created_epoch": "1395964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438732800000",
    "number": "1831516731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 BIRCH CT",
            "city": "LOCUST GROVE",
            "state": "VA",
            "postal_code": "225085720",
            "telephone_number": "856-520-3099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 WESTWOOD OFFICE PARK",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224015108",
            "telephone_number": "856-520-3099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARZOLINO",
        "first_name": "STACI",
        "middle_name": "BLAIR",
        "name_prefix": "Ms.",
        "credential": "LCSW, BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-28",
        "last_updated": "2015-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904007946",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "VA",
            "license": "0133000637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Washington Healthcare Specialty Services LLC
• Mary Washington Hospital
• Mary Washington Hospital Inc.
• Mary Washington Hospital, Inc. (Mary Washington Cardiology)
• Mary Washington Hospital, Inc. (Mary Washington Home Health Agency)
• Emily Masannat
• Amanda Mason, M.S., CCC-SLP
• Bonnie Mason
• Louis Benedict Massad, M.D.
• Caleb R Massey III, M.D.

• Behavior Analyst in Fredericksburg, VA
• Providers in Fredericksburg, VA by specialty
• Behavior Analyst in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2015; 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.