Individual
SAMUEL AARON TISSENBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
888 OAKWOOD RD STE 300, CHARLESTON, WV 25314-2071
(681) 265-0999
Mailing address
888 OAKWOOD ROAD, SUITE 300, BOX 2, CHARLESTON, WV 25314
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB790322
WV
Other
Enumeration date
06/08/2022
Last updated
06/08/2022
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