Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003335357 |
---|---|
Provider Name | Marissa Ann Senior |
First Address | Irvine, CA 92606-2417 |
Second Address | Carlsbad, CA 92008-2374 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2017 |
Last Update Date | 26/05/2020 |