Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-21-150717 | IN |
NPI | 1003407016 |
---|---|
Provider Name | Casey Herrera |
First Address | Indianapolis, IN 46268-6135 |
Second Address | Carmel, IN 46032-4688 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2021 |
Last Update Date | 02/02/2021 |