Healthcare Provider Details

I. General information

NPI: 1538667191
Provider Name (Legal Business Name): MACY MARIE MYERS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MACY MARIE PAULUS

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3428 W MARKET ST
FAIRLAWN OH
44333-3339
US

IV. Provider business mailing address

3428 W MARKET ST
FAIRLAWN OH
44333-3339
US

V. Phone/Fax

Practice location:
  • Phone: 330-668-4041
  • Fax:
Mailing address:
  • Phone: 330-668-4041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-69974
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: