Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1083134175 |
---|---|
Provider Name | Laura Marie Ferullo |
First Address | Sterling, VA 20166-6669 |
Second Address | Fairfax, VA 22031-3908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2017 |
Last Update Date | 21/06/2017 |