Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-21-12055 | FL |
N | 106S00000X | Behavior Technician |
NPI | 1164071080 |
---|---|
Provider Name | Djamila Serradet |
First Address | West Palm Beach, FL 33405-3422 |
Second Address | West Palm Beach, FL 33405-3422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2019 |
Last Update Date | 09/06/2021 |