Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-19-10487 | FL |
N | 106S00000X | Behavior Technician | 1620049 | FL |
NPI | 1154891836 |
---|---|
Provider Name | Laura Dezayas |
First Address | Hialeah, FL 33013-1239 |
Second Address | Seminole, FL 33776-4015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2018 |
Last Update Date | 23/09/2020 |