Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003374562 |
---|---|
Provider Name | Keana Salvi-Souza |
First Address | Wilmington, MA 01887-2179 |
Second Address | Wilmington, MA 01887-2179 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2019 |
Last Update Date | 04/03/2019 |