Provider Demographics
NPI:1396038139
Name:MASTRANGELO, MICHELLE (MED BCBA)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:MASTRANGELO
Suffix:
Gender:F
Credentials:MED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9775 E PASEO SAN BERNARDO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-5021
Mailing Address - Country:US
Mailing Address - Phone:520-820-3650
Mailing Address - Fax:520-886-6932
Practice Address - Street 1:9775 E PASEO SAN BERNARDO
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-5021
Practice Address - Country:US
Practice Address - Phone:520-820-3650
Practice Address - Fax:520-886-6932
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst