Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | MA |
NPI | 1063996767 |
---|---|
Provider Name | Ellaine Adu Ntoso |
First Address | Worcester, MA 01607-1037 |
Second Address | Worcester, MA 01607-1767 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2018 |
Last Update Date | 20/09/2018 |