Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1003305681 |
---|---|
Provider Name | Edna P Pina |
First Address | Woodland Hills, CA 91367-4976 |
Second Address | Stoughton, MA 02072-1163 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2018 |
Last Update Date | 09/05/2018 |