Individual
IDALISSE MARIE FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
35 WALNUT ST, WELLESLEY HILLS, MA 02481-2101
(617) 631-0219
Mailing address
35 WALNUT ST, WELLESLEY, MA 02481-2101
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/10/2022
Last updated
08/10/2022
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