Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003320367 |
---|---|
Provider Name | Samantha Nicolle Morales |
First Address | Fort Pierce, FL 34947-4727 |
Second Address | Stuart, FL 34997-6826 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2017 |
Last Update Date | 24/11/2017 |