Provider Demographics
NPI:1134598121
Name:HANNAH, MARY ELISABETH (MSED, BCBA)
Entity type:Individual
Prefix:
First Name:MARY ELISABETH
Middle Name:
Last Name:HANNAH
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 FERRIS AVE
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-1033
Mailing Address - Country:US
Mailing Address - Phone:401-339-0220
Mailing Address - Fax:
Practice Address - Street 1:345 FERRIS AVE
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:RI
Practice Address - Zip Code:02916-1033
Practice Address - Country:US
Practice Address - Phone:401-339-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-19
Last Update Date:2015-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
10-07-3808103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst