Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | VA |
NPI | 1043802796 |
---|---|
Provider Name | Indira A Montenegro |
First Address | North Chesterfield, VA 23236-3473 |
Second Address | North Chesterfield, VA 23236-3473 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2021 |
Last Update Date | 04/02/2021 |