Provider Demographics
NPI:1023669090
Name:MAHMOUD, VINCENT AHMED (MS, BCBA, IBA)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:AHMED
Last Name:MAHMOUD
Suffix:
Gender:M
Credentials:MS, BCBA, IBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 GANNET LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-9719
Mailing Address - Country:US
Mailing Address - Phone:908-420-7595
Mailing Address - Fax:
Practice Address - Street 1:5304 GANNET LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-9719
Practice Address - Country:US
Practice Address - Phone:908-420-7595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-21
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-18-30514103K00000X
CO1-18-30514103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst