Individual
KRISTA G CANON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
41 PACELLA PARK DR, RANDOLPH, MA 02368-1755
(781) 437-1323
Mailing address
6363 CHRISTIE AVE APT 402, EMERYVILLE, CA 94608-1916
(781) 437-1323
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
685661
TUFTS
MA
Enumeration date
02/12/2009
Last updated
02/12/2009
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