MEDICARE: MAKRIDIS LEARNING, LLC

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1720683378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAKRIDIS LEARNING, LLC

Provider Business Mailing Address
First Line	:	2920 HAMPSHIRE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43209-2651
Country	:	US
Telephone Number	:	937-470-5092
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 HAMPSHIRE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43209-2651
Country	:	US
Telephone Number	:	937-470-5092
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DIMITRIOS V. MAKRIDIS
Credential	:	BCBA
Telephone Number	:	937-470-5092

Provider Enumeration Date	:	12/02/2020
Last Update Date	:	03/24/2022

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