Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-18-73345 | CA |
NPI | 1003388976 |
---|---|
Provider Name | Megan Carberry |
First Address | Irvine, CA 92606-2417 |
Second Address | San Diego, CA 92103-4383 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2018 |
Last Update Date | 17/12/2018 |