Samantha Freeze Bronk, LBA
Individual provider Active NPI Behavior Analyst · Forest, VA
NPI 1902669732 · NPPES record last updated Feb 5, 2024
Key facts
- NPI
- 1902669732
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- License
- 0133003348 (VA)
- Practice address
- 2001 Enterprise Dr
Forest, VA 24551-2653 - Phone
- (434) 385-1089
- NPI assigned
- Feb 5, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0133003348 | VA | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Center for Pediatric Counseling | Behavior Analyst | Current |
Accepting new patients |
| Center for Pediatric Therapies, Inc. | Behavior Analyst | Past |
Accepting new patients |
Locations
175 Deer Run Rd
Danville, VA 24540
Phone (434) 797-5531
2001 Enterprise Dr
Forest, VA 24551
Phone (434) 386-8982
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 0133003348 | VA | Yes |
Addresses
Primary practice location
2001 Enterprise Dr
Forest, VA 24551-2653
Mailing address
2001 Enterprise Dr
Forest, VA 24551-2653
Phone (434) 385-1089
Other providers in Forest, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.