Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003385022 |
---|---|
Provider Name | Heather Bravo |
First Address | Fairfax, VA 22030-3132 |
Second Address | Fairfax, VA 22030-3132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2018 |
Last Update Date | 20/11/2018 |