Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | BCBA-19-37425 | FL |
N | 106E00000X | Assistant Behavior Analyst |
NPI | 1043610785 |
---|---|
Provider Name | Stephen Gordon |
First Address | Royal Palm Beach, FL 33411-8263 |
Second Address | Palm City, FL 34990-1747 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2014 |
Last Update Date | 12/02/2021 |