Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003210832 |
---|---|
Provider Name | Lisa Ann Glassford |
First Address | Brick, NJ 08724-1519 |
Second Address | Brick, NJ 08724-1519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2014 |
Last Update Date | 22/10/2014 |