MEDICARE: MAREN FARRIS MSED BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-10-7158	PA

General Provider Information

NPI Number	:	1588902472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAREN FARRIS MSED BCBA

Provider Business Mailing Address
First Line	:	7512 JACKSON AVE
Second Line	:
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-5707
Country	:	US
Telephone Number	:	484-995-0860
Fax Number	:

Provider Business Practice Location Address
First Line	:	7512 JACKSON AVE
Second Line	:
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-5707
Country	:	US
Telephone Number	:	484-995-0860
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2013
Last Update Date	:	10/27/2023

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