Provider Demographics
NPI:1316510175
Name:PROSOCIAL LEARNING GROUP, LLC
Entity type:Organization
Organization Name:PROSOCIAL LEARNING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:T
Authorized Official - Last Name:MAZUR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D
Authorized Official - Phone:202-903-4546
Mailing Address - Street 1:2730 MANRESA SHORE LN
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-3543
Mailing Address - Country:US
Mailing Address - Phone:202-903-4546
Mailing Address - Fax:
Practice Address - Street 1:2730 MANRESA SHORE LN
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-3543
Practice Address - Country:US
Practice Address - Phone:202-903-4546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty