Provider Demographics
NPI:1588209282
Name:NDIAYE, MABINTOU
Entity Type:Individual
Prefix:
First Name:MABINTOU
Middle Name:
Last Name:NDIAYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BROOKEBURY DR APT 1A
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-2945
Mailing Address - Country:US
Mailing Address - Phone:202-361-0751
Mailing Address - Fax:
Practice Address - Street 1:17 BROOKEBURY DR APT 1A
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-2945
Practice Address - Country:US
Practice Address - Phone:202-361-0751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD118548949Medicaid