Healthcare Provider Details

I. General information

NPI: 1659940716
Provider Name (Legal Business Name): MARIANA CORDIDO VEGA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8215 FOREST POINT BLVD STE 150
CHARLOTTE NC
28273-0219
US

IV. Provider business mailing address

10025 HEATHERLY CT
CHARLOTTE NC
28277-0274
US

V. Phone/Fax

Practice location:
  • Phone: 980-422-5887
  • Fax: 980-225-0025
Mailing address:
  • Phone: 305-798-0514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number4671
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: