Individual
MARY KEREDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA. BSL
Contact information
Practice address
131 JEFFORDS CT, PHOENIXVILLE, PA 19460-2842
(718) 414-5603
Mailing address
131 JEFFORDS CT, PHOENIXVILLE, PA 19460-2842
(718) 414-5603
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BH001389
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH001389
BUREAU OF PROFESSIONAL AND OCCCUPATIONAL AFFAIRS
PA
Enumeration date
07/09/2015
Last updated
07/09/2015
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