Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1104489970 |
---|---|
Provider Name | Evelyn Pena |
First Address | Swedesboro, NJ 08085-1021 |
Second Address | Orlando, FL 32837-6107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2019 |
Last Update Date | 17/04/2019 |