Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | BRT-20-143507 | FL |
NPI | 1003418849 |
---|---|
Provider Name | Joubert Fayette |
First Address | Naples, FL 34119-7711 |
Second Address | Naples, FL 34113-3347 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2020 |
Last Update Date | 16/11/2020 |