Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-18-33424 | CO |
N | 106S00000X | Behavior Technician |
NPI | 1003318429 |
---|---|
Provider Name | Kassen Pereira |
First Address | Irvine, CA 92606-2417 |
Second Address | Colorado Springs, CO 80906-4651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2018 |
Last Update Date | 23/01/2019 |