Provider Demographics
NPI:1174231096
Name:MANTEEN, MESSIAH-MA'AT (RBT)
Entity type:Individual
Prefix:
First Name:MESSIAH-MA'AT
Middle Name:
Last Name:MANTEEN
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12901 WOODMORE RD
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-4125
Mailing Address - Country:US
Mailing Address - Phone:516-983-8680
Mailing Address - Fax:
Practice Address - Street 1:4451 PARLIAMENT PL STE A
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-1868
Practice Address - Country:US
Practice Address - Phone:516-983-8680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MD106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE