| NPI | 1689160392 |
|---|---|
| Former Name | MATTAVIA BLACKWELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: GA 1-21-51736) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: SC RBT-17-34572) |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2024-07-30 |