Provider Demographics
NPI:1558608778
Name:MATHIAS, MALLORY ANNE (BCBA)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:ANNE
Last Name:MATHIAS
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 1:313 PLAZA DR
Mailing Address - Street 2:UNIT A5
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6931
Mailing Address - Country:US
Mailing Address - Phone:818-605-7451
Mailing Address - Fax:
Practice Address - Street 1:313 PLAZA DR
Practice Address - Street 2:UNIT A5
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6931
Practice Address - Country:US
Practice Address - Phone:818-605-7451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst