Individual
COURTNEY ROLER MAUZY IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA PHD
Contact information
Practice address
475 IRVING AVE, SYRACUSE, NY 13210-1756
(315) 464-3555
Mailing address
475 IRVING AVE, SUITE 300, SYRACUSE, NY 13210
(315) 464-3555
(315) 464-3551
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1-20-44673
GA
103T00000X
Psychologist
Primary
332649
NY
Other
Enumeration date
09/07/2023
Last updated
09/19/2024
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