Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1053870667 |
---|---|
Provider Name | Brenna Mullin |
First Address | Dracut, MA 01826-4559 |
Second Address | Dracut, MA 01826-4559 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2019 |
Last Update Date | 14/03/2019 |