Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-21-47252 | MA |
NPI | 1003286220 |
---|---|
Provider Name | Michelle Diaz |
First Address | Newton, MA 02464-1492 |
Second Address | Newton, MA 02464-1492 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2015 |
Last Update Date | 02/12/2021 |