Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-11-4166 |
NPI | 1124380142 |
---|---|
Provider Name | Mr. Brian Scott Mcconnell |
First Address | Atco, NJ 08004-1210 |
Second Address | Mount Laurel, NJ 08054-3965 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2012 |
Last Update Date | 16/04/2020 |