Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-13-12983 |
NPI | 1003320656 |
---|---|
Provider Name | Lisa Colbert |
First Address | West Hartford, CT 06110-2448 |
Second Address | West Hartford, CT 06110-2448 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2017 |
Last Update Date | 17/03/2018 |