Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1164064051 |
---|---|
Provider Name | Antoinette M Callahan |
First Address | Marlborough, MA 01752-5900 |
Second Address | Marlborough, MA 01752-5900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2019 |
Last Update Date | 11/10/2019 |