Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-20-146965 | CO |
NPI | 1003411158 |
---|---|
Provider Name | Anthony Rodriguez |
First Address | Nashville, TN 37217-2679 |
Second Address | Savannah, GA 31405-5841 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2020 |
Last Update Date | 18/03/2021 |