Provider Demographics
NPI:1730735952
Name:GUDZ, MARYERI (RBT)
Entity type:Individual
Prefix:
First Name:MARYERI
Middle Name:
Last Name:GUDZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14191 BRIDLE TRL
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-8904
Mailing Address - Country:US
Mailing Address - Phone:716-969-9380
Mailing Address - Fax:
Practice Address - Street 1:14191 BRIDLE TRL
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-8904
Practice Address - Country:US
Practice Address - Phone:716-969-9380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRBT-17-31298106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician