Provider Demographics
NPI:1629870696
Name:MANN, MARY LYNN (RBT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:MANN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 PINE SONG PL APT 203
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-5340
Mailing Address - Country:US
Mailing Address - Phone:757-679-8387
Mailing Address - Fax:
Practice Address - Street 1:355 HARBOR POINTE CT
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23523-2246
Practice Address - Country:US
Practice Address - Phone:757-275-5825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
421918103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst