Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | BH001527 | PA |
NPI | 1013335678 |
---|---|
Provider Name | Beth Raiola |
First Address | Stuart, FL 34997-7462 |
Second Address | Albuquerque, NM 87102-5312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2014 |
Last Update Date | 18/01/2021 |