Provider Demographics
NPI:1821319732
Name:MAZUR, ALISON (BCBA)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:MAZUR
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 1:4102 WATERFORD WAY
Mailing Address - Street 2:
Mailing Address - City:LIMERICK
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1389
Mailing Address - Country:US
Mailing Address - Phone:201-400-4243
Mailing Address - Fax:
Practice Address - Street 1:4102 WATERFORD WAY
Practice Address - Street 2:
Practice Address - City:LIMERICK
Practice Address - State:PA
Practice Address - Zip Code:19468-1389
Practice Address - Country:US
Practice Address - Phone:201-400-4243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-07-3320103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst