Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 900B | NY |
NPI | 1053826958 |
---|---|
Provider Name | Maryse Crececoeur |
First Address | Brooklyn, NY 11210-4958 |
Second Address | Brooklyn, NY 11226-4020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2017 |
Last Update Date | 13/12/2017 |