Provider Demographics
NPI:1164169025
Name:WILFORD, MARIA GABRIELA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:GABRIELA
Last Name:WILFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CMR 480 BOX 666
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09128-1007
Mailing Address - Country:US
Mailing Address - Phone:405-615-2906
Mailing Address - Fax:
Practice Address - Street 1:CMR 480 BOX 666
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09128-1007
Practice Address - Country:US
Practice Address - Phone:405-615-2906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
1-24-76945103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician