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NPI Code Detail

MEDICARE: BRANDY MARIE MAMO M.A., BCBA, LBA

MEDICARE: BRANDY MARIE MAMO M.A., BCBA, LBA
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 AnalystBEH-001437AZ

General Provider Information

NPI Number : 1356019269
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDY MARIE MAMO M.A., BCBA, LBA
Provider Business Mailing Address
First Line : 35433 N BLANFORD LN
Second Line :
City : SAN TAN VALLEY
State : AZ
Zip : 85140-0211
Country : US
Telephone Number : 386-338-7816
Fax Number :
Provider Business Practice Location Address
First Line : 2 N CENTRAL AVE STE 1800
Second Line :
City : PHOENIX
State : AZ
Zip : 85004-2139
Country : US
Telephone Number : 602-878-2493
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2021
Last Update Date : 04/13/2025

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