Provider Demographics
NPI:1740929199
Name:HUMMEL, MARY HANNAH (MS, BCBA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:HANNAH
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03442-4401
Mailing Address - Country:US
Mailing Address - Phone:603-831-3607
Mailing Address - Fax:
Practice Address - Street 1:17 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NH
Practice Address - Zip Code:03442-4401
Practice Address - Country:US
Practice Address - Phone:603-831-3607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-51186103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst