Individual
TASIA SUPINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
30 CARNEY ST, MEDFORD, MA 02155-2802
(508) 838-1114
Mailing address
30 CARNEY ST, MEDFORD, MA 02155-2802
(508) 838-1114
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
07/17/2015
Last updated
07/17/2015
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