Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003373705 |
---|---|
Provider Name | Andrew Collins |
First Address | Media, PA 19063-2574 |
Second Address | Media, PA 19063-2574 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2019 |
Last Update Date | 28/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RBT-18-62374 | BACB REGISTRATION NUMBER (01) |