Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | 0134000220 | VA |
Y | 106E00000X | Assistant Behavior Analyst | 0134000220 | VA |
NPI | 1043701311 |
---|---|
Provider Name | Erica Yamilex Benitez |
First Address | Woodbridge, VA 22191-1965 |
Second Address | Annandale, VA 22003-2645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2018 |
Last Update Date | 16/09/2021 |