Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | BH003123 | PA |
NPI | 1083164644 |
---|---|
Provider Name | Ms. Luciana Genevieve Mayo |
First Address | Upper Darby, PA 19082-1517 |
Second Address | Trevose, PA 19053-6944 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2016 |
Last Update Date | 07/10/2016 |