Provider Demographics
NPI:1952762536
Name:GOETZ, MAUREEN CANDICE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:CANDICE
Last Name:GOETZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MISS
Other - First Name:MAUREEN
Other - Middle Name:CANDICE
Other - Last Name:EARLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1937 CHURCHILL DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2212
Mailing Address - Country:US
Mailing Address - Phone:317-450-3333
Mailing Address - Fax:
Practice Address - Street 1:1937 CHURCHILL DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2212
Practice Address - Country:US
Practice Address - Phone:317-450-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst