Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003303876 |
---|---|
Provider Name | Lisa R Mccarthy |
First Address | Dubuque, IA 52001-1397 |
Second Address | Dubuque, IA 52001-1397 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2018 |
Last Update Date | 17/04/2018 |