Provider Demographics
NPI:1609118108
Name:SYLVESTER, MARY JANEAN (BCBA, LBS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANEAN
Last Name:SYLVESTER
Suffix:
Gender:F
Credentials:BCBA, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 273
Mailing Address - Street 2:
Mailing Address - City:TERRE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17581-0273
Mailing Address - Country:US
Mailing Address - Phone:717-940-4834
Mailing Address - Fax:
Practice Address - Street 1:412 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:TERRE HILL
Practice Address - State:PA
Practice Address - Zip Code:17581
Practice Address - Country:US
Practice Address - Phone:717-940-4834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2023-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT11520997103K00000X
PABH006468103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst