Individual
COLLEEN MARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
545 WIGARD AVE, PHILADELPHIA, PA 19128-3131
(267) 342-3655
Mailing address
545 WIGARD AVE, PHILADELPHIA, PA 19128-3131
(267) 342-3655
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BH003096
PA
Other
Enumeration date
06/14/2016
Last updated
06/14/2016
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