Provider Demographics
NPI:1073062212
Name:WICKS, MARIE CATHRYN (MA BCBA LBS)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:CATHRYN
Last Name:WICKS
Suffix:
Gender:F
Credentials:MA BCBA LBS
Other - Prefix:MISS
Other - First Name:MARIE
Other - Middle Name:CATHRYN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA BCBA LBS
Mailing Address - Street 1:1029 LITTLE ELK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19363-2812
Mailing Address - Country:US
Mailing Address - Phone:610-563-8519
Mailing Address - Fax:
Practice Address - Street 1:1029 LITTLE ELK CREEK RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:PA
Practice Address - Zip Code:19363-2812
Practice Address - Country:US
Practice Address - Phone:610-563-8519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003069103K00000X
PA1-16-21731103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst