Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003416736 |
---|---|
Provider Name | Andrea Fox |
First Address | Pasadena, CA 91106-2327 |
Second Address | Bethesda, MD 20817-1005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2020 |
Last Update Date | 30/10/2020 |