Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-20-10916 | FL |
N | 106S00000X | Behavior Technician | RBT-17-35692 | FL |
NPI | 1154851905 |
---|---|
Provider Name | E'syl Ray |
First Address | Melbourne, FL 32901-1900 |
Second Address | Melbourne, FL 32901-1900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2017 |
Last Update Date | 28/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02138900 | (05) | FL |