Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003366626 |
---|---|
Provider Name | Lynn Shin |
First Address | Cliffside Park, NJ 07010-3236 |
Second Address | Cliffside Park, NJ 07010-3236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2016 |
Last Update Date | 13/10/2016 |