Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 082772436 | CT |
NPI | 1003293572 |
---|---|
Provider Name | Donald Hernberg |
First Address | Willimantic, CT 06226-3530 |
Second Address | Willimantic, CT 06226-3530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2015 |
Last Update Date | 04/05/2015 |