Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-17-7698 | FL |
NPI | 1033525167 |
---|---|
Provider Name | Amanda Nino |
First Address | Doral, FL 33172-1416 |
Second Address | Doral, FL 33172-1416 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2014 |
Last Update Date | 18/09/2019 |