Provider Demographics
NPI:1851027031
Name:SIGNORELLA, MARY E (MA BCBA LBA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:SIGNORELLA
Suffix:
Gender:F
Credentials:MA BCBA LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 YALE ST APT 359
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2845
Mailing Address - Country:US
Mailing Address - Phone:630-408-8442
Mailing Address - Fax:
Practice Address - Street 1:2665 ROYAL FRST STE B200
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-5045
Practice Address - Country:US
Practice Address - Phone:630-408-8442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5190103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty