Healthcare Provider Details

I. General information

NPI: 1457899585
Provider Name (Legal Business Name): MARY MAHONEY BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY HIGGINS BCBA

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43B FRANKLIN ST
WINOOSKI VT
05404-1809
US

IV. Provider business mailing address

43B FRANKLIN ST
WINOOSKI VT
05404-1809
US

V. Phone/Fax

Practice location:
  • Phone: 802-238-0950
  • Fax:
Mailing address:
  • Phone: 802-238-0950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number3133
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA10001811
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA2534
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number15BC00270400
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number146-0132046
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: