Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003323056 |
---|---|
Provider Name | Mariah Mazzariello |
First Address | Virginia Beach, VA 23452-1537 |
Second Address | Fredericksburg, VA 22401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2017 |
Last Update Date | 17/03/2018 |