MEDICARE: MOTHERLY EMBRACE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	103TM1800X	Intellectual & Developmental Disabilities Psychologist
3	106E00000X	Assistant Behavior Analyst
4	106S00000X	Behavior Technician
5	171000000X	Military Health Care Provider
6	174H00000X	Health Educator
7	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
8	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1508645276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOTHERLY EMBRACE

Provider Business Mailing Address
First Line	:	10985 PACIFIC POINT PL UNIT 1203
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2088
Country	:	US
Telephone Number	:	858-253-0809
Fax Number	:

Provider Business Practice Location Address
First Line	:	10985 PACIFIC POINT PL UNIT 1203
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2088
Country	:	US
Telephone Number	:	858-253-0809
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	IFAH S GRADY
Credential	:
Telephone Number	:	858-253-0809

Provider Enumeration Date	:	09/22/2023
Last Update Date	:	09/22/2023

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Directions to “MOTHERLY EMBRACE ” Practice Location

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