Provider Demographics
NPI:1972870152
Name:CLEEVE, MODUPEH (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:MODUPEH
Middle Name:
Last Name:CLEEVE
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 1:9348 CHERRY HILL RD
Mailing Address - Street 2:APT. 323
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-1241
Mailing Address - Country:US
Mailing Address - Phone:301-526-5449
Mailing Address - Fax:
Practice Address - Street 1:9348 CHERRY HILL RD
Practice Address - Street 2:APT. 323
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1241
Practice Address - Country:US
Practice Address - Phone:301-526-5449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1-11-9371101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health