Provider Demographics
NPI:1164263760
Name:M & D BEHAVIORAL CONSULTANT LLC
Entity type:Organization
Organization Name:M & D BEHAVIORAL CONSULTANT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MAIMOUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIALLO
Authorized Official - Suffix:
Authorized Official - Credentials:LBS
Authorized Official - Phone:215-480-0383
Mailing Address - Street 1:2632 S 70TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19142-1703
Mailing Address - Country:US
Mailing Address - Phone:215-480-0383
Mailing Address - Fax:
Practice Address - Street 1:2632 S 70TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142-1703
Practice Address - Country:US
Practice Address - Phone:215-480-0383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty