Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-14-10005 |
NPI | 1013308584 |
---|---|
Provider Name | Juliya Krasnopolsky |
First Address | Andover, MA 01810-4213 |
Second Address | Andover, MA 01810-4213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2015 |
Last Update Date | 05/02/2015 |