Provider Demographics
NPI:1881835098
Name:DIMICELI, MARY-CLAIRE CATHLEEN (MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MARY-CLAIRE
Middle Name:CATHLEEN
Last Name:DIMICELI
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 PINE MANOR DR
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2364
Mailing Address - Country:US
Mailing Address - Phone:917-324-2933
Mailing Address - Fax:
Practice Address - Street 1:424 PINE MANOR DR
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2364
Practice Address - Country:US
Practice Address - Phone:917-324-2933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-08-4869103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst