Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003412677 |
---|---|
Provider Name | Matthew Chamberlain |
First Address | Wormleysburg, PA 17043-1104 |
Second Address | Wormleysburg, PA 17043-1104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2020 |
Last Update Date | 19/04/2021 |