Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003119504 |
---|---|
Provider Name | Mrs. Kerri S. Licini |
First Address | Orange Park, FL 32073-2337 |
Second Address | Orange Park, FL 32073-2337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2010 |
Last Update Date | 22/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1-13-14323 | 1-13-14323 (01) |