Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003305830 |
---|---|
Provider Name | Ms. Carla Gavilanes |
First Address | Briarwood, NY 11435-2832 |
Second Address | Bellmore, NY 11710-5730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2018 |
Last Update Date | 25/09/2018 |