Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-21-12167 | CA |
NPI | 1154095651 |
---|---|
Provider Name | Robert Azevedo Silveira |
First Address | Stuart, FL 34997-7462 |
Second Address | Sacramento, CA 95825-6540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2021 |
Last Update Date | 30/09/2021 |