Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106E00000X | Assistant Behavior Analyst | ||
Y | 106S00000X | Behavior Technician |
NPI | 1164948790 |
---|---|
Provider Name | Marissa Jo Weis |
First Address | Clermont, FL 34711-7342 |
Second Address | Clermont, FL 34711-7342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2017 |
Last Update Date | 16/02/2021 |