Provider Demographics
NPI:1124366760
Name:PAVLICA, MARY ANNE (BCBA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:PAVLICA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 JACKSON PL
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1147
Mailing Address - Country:US
Mailing Address - Phone:516-785-0595
Mailing Address - Fax:
Practice Address - Street 1:2211 JACKSON PL
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1147
Practice Address - Country:US
Practice Address - Phone:516-785-0595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst