Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-17-29483 | CO |
NPI | 1003355645 |
---|---|
Provider Name | Veronica Goldberg |
First Address | Centennial, CO 80112-1283 |
Second Address | Centennial, CO 80112-1283 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2017 |
Last Update Date | 15/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RBT-17-29483 | BABC (01) | CO |