Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 106E00000X | Assistant Behavior Analyst | K61352592865 | FL |
NPI | 1013458058 |
---|---|
Provider Name | Lauren Kervitsky |
First Address | Lake Mary, FL 32746-3625 |
Second Address | Orlando, FL 32832-6087 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2017 |
Last Update Date | 12/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
K613525928650 | (05) | FL |