Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 106S00000X | Behavior Technician |
NPI | 1003479692 |
---|---|
Provider Name | Jamisha Marie Martin |
First Address | Alameda, CA 94501-1188 |
Second Address | Alameda, CA 94501-1189 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2019 |
Last Update Date | 23/04/2019 |