Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
Y | 103K00000X | Behavior Analyst | 1-17-27429 |
NPI | 1013361344 |
---|---|
Provider Name | Melissa Bruce |
First Address | Waldorf, MD 20603-4632 |
Second Address | Honolulu, HI 96817-3950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2016 |
Last Update Date | 09/02/2021 |