Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-15-6591 | FL |
NPI | 1174058408 |
---|---|
Provider Name | Nicole M Young |
First Address | Stuart, FL 34997-6826 |
Second Address | Orlando, FL 32812-7610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2017 |
Last Update Date | 24/04/2017 |