Provider Demographics
NPI:1487023123
Name:MCRAE, MARY (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:MCRAE
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 1:402 FAIRLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1751
Mailing Address - Country:US
Mailing Address - Phone:251-689-1658
Mailing Address - Fax:
Practice Address - Street 1:402 FAIRLAND AVE
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1751
Practice Address - Country:US
Practice Address - Phone:251-689-1658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst