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NPI Code Detail

MEDICARE: MARIAH LYNN GONZALEZ

MEDICARE: MARIAH LYNN GONZALEZ
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1487483137
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIAH LYNN GONZALEZ
Provider Business Mailing Address
First Line : 2000 ASH ST
Second Line :
City : SCRANTON
State : PA
Zip : 18510-1546
Country : US
Telephone Number : 570-829-9407
Fax Number :
Provider Business Practice Location Address
First Line : 2000 ASH ST
Second Line :
City : SCRANTON
State : PA
Zip : 18510-1546
Country : US
Telephone Number : 570-829-9407
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2024
Last Update Date : 07/31/2024

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Directions to “ MARIAH LYNN GONZALEZ ” Practice Location

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