Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-19-9673 | FL |
N | 106S00000X | Behavior Technician |
NPI | 1013410919 |
---|---|
Provider Name | Lindell Melissa Peterson |
First Address | Altamonte Springs, FL 32701-5253 |
Second Address | Casselberry, FL 32707-5372 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2018 |
Last Update Date | 26/03/2019 |