Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 1062795 | MA |
Y | 103K00000X | Behavior Analyst | 848 | MA |
NPI | 1013083641 |
---|---|
Provider Name | Miss Theresa E Taylor |
First Address | Rutland, MA 01543-1111 |
Second Address | Rutland, MA 01543-1239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2006 |
Last Update Date | 21/04/2018 |