Provider Demographics
NPI:1356067425
Name:SERRATO, MARY (RBT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SERRATO
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52906 BAY DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:MI
Mailing Address - Zip Code:49056-9492
Mailing Address - Country:US
Mailing Address - Phone:219-313-3580
Mailing Address - Fax:
Practice Address - Street 1:137 W MONROE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:MI
Practice Address - Zip Code:49013-1332
Practice Address - Country:US
Practice Address - Phone:219-313-3580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-22-238976106S00000X
106S00000X
RBT-24-38951106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician