Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1063933885 |
---|---|
Provider Name | Marlena Jacobson |
First Address | Santa Cruz, CA 95062-5124 |
Second Address | Santa Cruz, CA 95062-5124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2017 |
Last Update Date | 30/06/2017 |