Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1043895949 |
---|---|
Provider Name | Ms. Selene Fade |
First Address | Valencia, CA 91355-4983 |
Second Address | Valencia, CA 91355-4983 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2021 |
Last Update Date | 11/03/2021 |