Provider Demographics
NPI:1437630944
Name:ROSE, MARIAH ANN (RBT)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:ANN
Last Name:ROSE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:ANN
Other - Last Name:PAZYCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:408 S JONES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2658
Mailing Address - Country:US
Mailing Address - Phone:702-502-8021
Mailing Address - Fax:866-833-2056
Practice Address - Street 1:408 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2658
Practice Address - Country:US
Practice Address - Phone:702-502-8021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106S00000X
MORBT-18-57306106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician