Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | ||
N | 106S00000X | Behavior Technician |
NPI | 1053969154 |
---|---|
Provider Name | Angelina Marietta Stevens |
First Address | Hemet, CA 92543-1810 |
Second Address | Hemet, CA 92543-1810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2019 |
Last Update Date | 31/08/2019 |