Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-20-11584 | FL |
NPI | 1013515584 |
---|---|
Provider Name | Brianna Candelori |
First Address | Stuart, FL 34997-7462 |
Second Address | Fort Myers, FL 33905-7808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2020 |
Last Update Date | 18/10/2021 |