Provider Demographics
NPI:1104244748
Name:ROHDE, MARY JOHNSON (BCBA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JOHNSON
Last Name:ROHDE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 BELLGROVE DR
Mailing Address - Street 2:
Mailing Address - City:DESTREHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70047-2523
Mailing Address - Country:US
Mailing Address - Phone:504-231-3235
Mailing Address - Fax:
Practice Address - Street 1:8550 UNITED PLAZA BLVD
Practice Address - Street 2:SUITE 702 N
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2256
Practice Address - Country:US
Practice Address - Phone:888-880-9270
Practice Address - Fax:954-342-0273
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1-14-15444103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst