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NPI Code Detail

MEDICARE: MOLLY MATHIAS BCBA

MEDICARE: MOLLY MATHIAS 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
1103K00000XBehavior Analyst1-15-18209IN

General Provider Information

NPI Number : 1629449046
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLY MATHIAS BCBA
Provider Business Mailing Address
First Line : 2630 S ARLINGTON AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46203-5701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2630 S ARLINGTON AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46203-5701
Country : US
Telephone Number : 317-966-0200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2015
Last Update Date : 10/12/2015

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