Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-19-9559 |
NPI | 1043830300 |
---|---|
Provider Name | Carmen Bartolone |
First Address | Mount Laurel, NJ 08054-3965 |
Second Address | Mount Laurel, NJ 08054-3965 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2020 |
Last Update Date | 16/04/2020 |