Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003347600 |
---|---|
Provider Name | Vianca Acosta |
First Address | Bronx, NY 10451-5601 |
Second Address | Bronx, NY 10451-5601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2017 |
Last Update Date | 24/03/2017 |