Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003122144 |
---|---|
Provider Name | Ms. Ronisha Le Velvet Blackeney |
First Address | Las Vegas, NV 89108-4929 |
Second Address | Las Vegas, NV 89108-4929 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2010 |
Last Update Date | 26/08/2010 |