Mary Malisa Mathew
Behavior Technician in Wheaton, IL. Individual provider (NPI-1).
NPI number1669922647
StatusActive
Last updated in NPPESJun 21, 2021
Details
- NPI
- 1669922647
- Entity type
- Individual (NPI-1)
- Name
- Ms. Mary Malisa Mathew
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Oct 13, 2016
- Certification date
- Jun 21, 2021
- Last updated
- Jun 21, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
1725 S Naperville Rd Ste 110Wheaton, IL 60189-5855
Phone 815-469-1500
Mailing address
123 Kingfield RdPhiladelphia, PA 19115-4024
Phone 267-441-5817
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All 58 Behavior Technician providers in Wheaton · All 2,946 providers in Wheaton
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