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General NPI Number Information
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NPI Number | 1316510175
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Entity Type | Organization
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Legal Business Name | PROSOCIAL LEARNING GROUP, LLC
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Dates
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Enumeration Date | 07/20/2021
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Last Update Date | 07/20/2021
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Provider Practice Location Address
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Address Line | 2730 MANRESA SHORE LN
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City | OAKLEY
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State | CA
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Zip | 94561-3543
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Country | US
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Telephone | 202-903-4546
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Fax |
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Provider Business Mailing Address
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Address Line | 2730 MANRESA SHORE LN
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City | OAKLEY
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State | CA
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Zip | 94561-3543
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Country | US
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Telephone | 202-903-4546
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRITTANY T MAZUR
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Credential | PHD, BCBA-D
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Telephone | 202-903-4546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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