Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003450784 |
---|---|
Provider Name | Kimberly Ann Boutin |
First Address | East Wareham, MA 02538-1135 |
Second Address | East Sandwich, MA 02537-1438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2019 |
Last Update Date | 05/11/2019 |