Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 11521250 | NJ |
NPI | 1003264565 |
---|---|
Provider Name | Ms. Alyson Terese Detig |
First Address | New Providence, NJ 07974-1745 |
Second Address | Stirling, NJ 07980-1523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2016 |
Last Update Date | 25/05/2016 |