Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003319468 |
---|---|
Provider Name | Nicole Behrle |
First Address | Odenton, MD 21113-3411 |
Second Address | Odenton, MD 21113-3411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2018 |
Last Update Date | 13/03/2018 |