MEDICARE: MRS. HELEN PHAEDRA MADER M.A., B.C.B.A.

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	1-04-1503

General Provider Information

NPI Number	:	1740597012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HELEN PHAEDRA MADER M.A., B.C.B.A.

Provider Business Mailing Address
First Line	:	18726 S WESTERN AVE
Second Line	:	SUITE 408
City	:	GARDENA
State	:	CA
Zip	:	90248-3813
Country	:	US
Telephone Number	:	310-856-0800
Fax Number	:	310-324-3134

Provider Business Practice Location Address
First Line	:	18726 S WESTERN AVE
Second Line	:	SUITE 408
City	:	GARDENA
State	:	CA
Zip	:	90248-3813
Country	:	US
Telephone Number	:	310-856-0800
Fax Number	:	310-324-3134

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

Provider Enumeration Date	:	09/08/2010
Last Update Date	:	09/08/2010

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