Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
Y | 106E00000X | Assistant Behavior Analyst | 0188950 | FL |
NPI | 1003270281 |
---|---|
Provider Name | Mariah Nelson |
First Address | Sarasota, FL 34238-5684 |
Second Address | Englewood, FL 34223-2756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2016 |
Last Update Date | 19/11/2018 |