Provider Demographics
NPI:1699114694
Name:MAMROS, DENISE A (MA, BCBA)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:A
Last Name:MAMROS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HOMER CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15748-1334
Mailing Address - Country:US
Mailing Address - Phone:724-388-3060
Mailing Address - Fax:
Practice Address - Street 1:121 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:HOMER CITY
Practice Address - State:PA
Practice Address - Zip Code:15748-1334
Practice Address - Country:US
Practice Address - Phone:724-388-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-23
Last Update Date:2013-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst