Healthcare Provider Details

I. General information

NPI: 1235613100
Provider Name (Legal Business Name): MARIAH WESTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N CENTRAL AVE STE 1800
PHOENIX AZ
85004-2139
US

IV. Provider business mailing address

175 BELGROVE DR
KEARNY NJ
07032-1507
US

V. Phone/Fax

Practice location:
  • Phone: 201-979-1336
  • Fax: 908-940-0338
Mailing address:
  • Phone: 201-979-1336
  • Fax: 908-940-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-000387
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: