Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | LBA00217 | RI |
NPI | 1003356163 |
---|---|
Provider Name | Amanda L.a. Mollis |
First Address | Pasadena, CA 91106-2380 |
Second Address | Providence, RI 02903-2014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2017 |
Last Update Date | 15/07/2020 |