Provider Demographics
NPI:1356019269
Name:MAMO, BRANDY MARIE (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:MARIE
Last Name:MAMO
Suffix:
Gender:
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 1:35433 N BLANFORD LN
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-0211
Mailing Address - Country:US
Mailing Address - Phone:386-338-7816
Mailing Address - Fax:
Practice Address - Street 1:2 N CENTRAL AVE STE 1800
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2139
Practice Address - Country:US
Practice Address - Phone:602-878-2493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-001437103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1356019269OtherHOME HEALTH