Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | 17-32380 | FL |
NPI | 1003340324 |
---|---|
Provider Name | Victoria Blake |
First Address | Naples, FL 34116-7459 |
Second Address | Naples, FL 34116-7459 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2017 |
Last Update Date | 13/04/2017 |