Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-09-5698 | MA |
NPI | 1013334382 |
---|---|
Provider Name | Ronald Allen |
First Address | Cambridge, MA 02138-1573 |
Second Address | Cambridge, MA 02138-1573 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2014 |
Last Update Date | 25/03/2014 |