Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | CA |
NPI | 1003423187 |
---|---|
Provider Name | Kacey Allison Berberich |
First Address | Honolulu, HI 96815-3179 |
Second Address | Honolulu, HI 96818-3172 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2020 |
Last Update Date | 23/09/2020 |