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NPI Code Detail

MEDICARE: GRACE KELLY MAIER

MEDICARE: GRACE KELLY MAIER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst002327NY

General Provider Information

NPI Number : 1154984813
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE KELLY MAIER
Provider Business Mailing Address
First Line : PO BOX 9497
Second Line :
City : ALTA LOMA
State : CA
Zip : 91701-8470
Country : US
Telephone Number : 909-961-4760
Fax Number :
Provider Business Practice Location Address
First Line : 1460 BROADWAY STE 920
Second Line :
City : NEW YORK
State : NY
Zip : 10036-7329
Country : US
Telephone Number : 212-235-5043
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2019
Last Update Date : 08/30/2022

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Directions to “ GRACE KELLY MAIER ” Practice Location

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