Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003401381 |
---|---|
Provider Name | Angelica Marie Roman |
First Address | Glendale, CA 91206-2427 |
Second Address | Holyoke, MA 01040-1662 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2021 |
Last Update Date | 08/03/2021 |