Provider Demographics
NPI:1639596174
Name:FOSS, MAUREEN (BCBA)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:FOSS
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 1:39 BANGOR ST
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-1711
Mailing Address - Country:US
Mailing Address - Phone:207-521-5230
Mailing Address - Fax:855-596-2438
Practice Address - Street 1:1325 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4945
Practice Address - Country:US
Practice Address - Phone:302-244-3404
Practice Address - Fax:855-596-2438
Is Sole Proprietor?:No
Enumeration Date:2014-03-22
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000410103K00000X
103K00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1295235448Medicaid
ME1295235448Medicaid