Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1013229046 |
---|---|
Provider Name | Kirk Cervetti |
First Address | Memphis, TN 38119-8735 |
Second Address | Memphis, TN 38134-7317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2010 |
Last Update Date | 07/07/2010 |