Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003355082 |
---|---|
Provider Name | Fabiola Duverger |
First Address | Lakewood, NJ 08701-5675 |
Second Address | Lakewood, NJ 08701-5675 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2017 |
Last Update Date | 26/02/2019 |