Provider Demographics
NPI:1649642687
Name:KATZ, MARA (BCBA, COBA)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:KATZ
Suffix:
Gender:F
Credentials:BCBA, COBA
Other - Prefix:
Other - First Name:MARNIE
Other - Middle Name:
Other - Last Name:KATZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1709 CHELMSFORD RD STE 207
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3302
Mailing Address - Country:US
Mailing Address - Phone:440-421-9053
Mailing Address - Fax:
Practice Address - Street 1:4949 GALAXY PKWY STE W
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5959
Practice Address - Country:US
Practice Address - Phone:216-508-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOBA.00377103K00000X
OH1-15-19850103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1-15-19850OtherBCBA
OHCOBA.00377OtherCOBA