Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003328683 |
---|---|
Provider Name | Emily Johnson |
First Address | Boston, MA 02215-1506 |
Second Address | Boston, MA 02215-1506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2017 |
Last Update Date | 03/11/2017 |