Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | NV |
NPI | 1003475997 |
---|---|
Provider Name | Carolene Estephane Rodezno |
First Address | Woodland Hills, CA 91367-7807 |
Second Address | Las Vegas, NV 89117-1572 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2019 |
Last Update Date | 13/06/2019 |