Individual
MARCUS ANTONIO ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
148 HALLECK AVE, RIVERSIDE, RI 02915-3511
(140) 164-9308
Mailing address
148 HALLECK AVE, RIVERSIDE, RI 02915-3511
(401) 649-3086
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/14/2023
Last updated
11/14/2023
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