Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-20-10738 | NJ |
NPI | 1063045896 |
---|---|
Provider Name | Jessica Smith |
First Address | Piscataway, NJ 08854-3770 |
Second Address | Bridgewater, NJ 08807-3670 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2020 |
Last Update Date | 20/02/2020 |