Healthcare Provider Details

I. General information

NPI: 1740882992
Provider Name (Legal Business Name): MORGAN ALEXIS MABRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 FORBES BLVD
LANHAM MD
20706-4445
US

IV. Provider business mailing address

4301 FORBES BLVD
LANHAM MD
20706-4445
US

V. Phone/Fax

Practice location:
  • Phone: 443-539-2357
  • Fax:
Mailing address:
  • Phone: 443-539-2357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-72261
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: