Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1013308444 |
---|---|
Provider Name | Anisah Pride |
First Address | Malvern, PA 19355-1515 |
Second Address | Malvern, PA 19355-1515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2015 |
Last Update Date | 06/02/2015 |