Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-04-1475 | FL |
NPI | 1104084185 |
---|---|
Provider Name | Mrs. Nicole Danielle Manassa |
First Address | Bradenton, FL 34207-1953 |
Second Address | Bradenton, FL 34210-2632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2008 |
Last Update Date | 29/07/2020 |