Provider Demographics
NPI:1598007551
Name:TRAHAN, MARANDA A (PHD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:MARANDA
Middle Name:A
Last Name:TRAHAN
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 FLEET ST
Mailing Address - Street 2:1
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-3026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2019 FLEET ST
Practice Address - Street 2:1
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-3026
Practice Address - Country:US
Practice Address - Phone:985-628-2286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-17
Last Update Date:2013-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-08-4541103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst