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Individual

GINA MASTROIANNI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
BCBA, LBA

Contact information

Practice address
465 ELROD AVE # 101, COOS BAY, OR 97420-1532
(541) 756-6232
Mailing address
465 ELROD AVE # 101, COOS BAY, OR 97420-1532
(541) 756-6232

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
B-10213319
OR
103K00000X
Behavior Analyst
BEH-000567
AZ

Other

Enumeration date
04/13/2020
Last updated
07/06/2021
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