MEDICARE: MARY ELIZABETH GOLDEN BCBA

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	1-25-80640	GA

General Provider Information

NPI Number	:	1760333041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH GOLDEN BCBA

Provider Business Mailing Address
First Line	:	7440 HIGHWAY 92
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-5235
Country	:	US
Telephone Number	:	770-212-2170
Fax Number	:	770-783-8639

Provider Business Practice Location Address
First Line	:	7440 HIGHWAY 92
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-5235
Country	:	US
Telephone Number	:	770-212-2170
Fax Number	:	770-783-8639

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

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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