Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 000715 | CT |
NPI | 1003469941 |
---|---|
Provider Name | Ms. Carole Mcdonald |
First Address | Glastonbury, CT 06033-2218 |
Second Address | Glastonbury, CT 06033-2218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2019 |
Last Update Date | 19/07/2019 |