MEDICARE: MAYA ICELA PRIETO

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
1	106S00000X	Behavior Technician		AZ

General Provider Information

NPI Number	:	1457209454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYA ICELA PRIETO

Provider Business Mailing Address
First Line	:	945 N CENTRAL AVE
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-1604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 E WASHINGTON ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-1903
Country	:	US
Telephone Number	:	516-206-8900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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Directions to “ MAYA ICELA PRIETO ” Practice Location

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