Provider Demographics
NPI:1033540737
Name:RASCO, MARY GRAHAM (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:MARY GRAHAM
Middle Name:
Last Name:RASCO
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 TEER RD
Mailing Address - Street 2:
Mailing Address - City:WEST RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05777-5500
Mailing Address - Country:US
Mailing Address - Phone:802-855-3388
Mailing Address - Fax:
Practice Address - Street 1:516 TEER RD
Practice Address - Street 2:
Practice Address - City:WEST RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05777-5500
Practice Address - Country:US
Practice Address - Phone:802-855-3388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1-12-12023103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst