Provider Demographics
NPI:1306102652
Name:DIMARIA, CATHLEEN (BCABA)
Entity type:Individual
Prefix:MRS
First Name:CATHLEEN
Middle Name:
Last Name:DIMARIA
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 BRONCO CIR
Mailing Address - Street 2:
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976
Mailing Address - Country:US
Mailing Address - Phone:215-491-7377
Mailing Address - Fax:215-491-2937
Practice Address - Street 1:1313 BRONCO CIR
Practice Address - Street 2:
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-1907
Practice Address - Country:US
Practice Address - Phone:215-491-7377
Practice Address - Fax:215-491-2937
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0-11-4313103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst