MEDICARE: NATALIE MANN

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	:	1972198620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE MANN

Provider Business Mailing Address
First Line	:	560 SYLVAN AVE STE 1110
Second Line	:
City	:	ENGLEWOOD CLIFFS
State	:	NJ
Zip	:	07632-3118
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10475 CROSSPOINT BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-3386
Country	:	US
Telephone Number	:	615-570-9959
Fax Number	:	646-859-4440

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

Provider Enumeration Date	:	03/04/2021
Last Update Date	:	03/04/2021

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