Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1073630 | FL |
NPI | 1013244458 |
---|---|
Provider Name | Mrs. Bridget J Caron |
First Address | Ponte Vedra Beach, FL 32082-2623 |
Second Address | Orange Park, FL 32073-4532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2009 |
Last Update Date | 05/11/2009 |