Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-21-12659 | MI |
N | 106S00000X | Behavior Technician | RBT-19-74919 | MI |
NPI | 1093208142 |
---|---|
Provider Name | Adrianna Marisol Pena-Van Den Bossche |
First Address | Livonia, MI 48150-1848 |
Second Address | Coral Gables, FL 33134-4108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2018 |
Last Update Date | 25/08/2021 |