Mariah Michelle Andersen
Individual provider Active NPI Behavior Technician · Vallejo, CA
NPI 1053938258 · NPPES record last updated Jul 3, 2020
Key facts
- NPI
- 1053938258
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- Practice address
- 150 Glen Cove Marina Rd E Ste 102
Vallejo, CA 94591-7237 - Phone
- (707) 553-1784
- NPI assigned
- Jul 3, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | CA | Yes |
Addresses
Primary practice location
150 Glen Cove Marina Rd E Ste 102
Vallejo, CA 94591-7237
Mailing address
932 Hickory Ave
Fairfield, CA 94533-7002
Phone (707) 623-7021
Other providers in Vallejo, CA
- Amt - Grove LLC
- Chude Anene Anagor
- Amar Anand
- Stephen Jonathan Ancheta
- Anchored California Licensed Professional Clinical Counselor, Inc.
- Mark Edward Andersen
- Andre Anderson
- Carly Anderson
- Emilia Anderson
- Everlee Rose Anderson
All providers in Vallejo, CA · Behavior Technician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2020. 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.