Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1003384090 |
---|---|
Provider Name | Jaymmy Matias-Cruz |
First Address | Fall River, MA 02721-3015 |
Second Address | Fall River, MA 02721-3015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2018 |
Last Update Date | 07/11/2018 |