Individual
GANNA DOLGOPOLOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
44 SCHOOL ST RM 325, BOSTON, MA 02108-4209
(857) 498-0814
Mailing address
27777 INKSTER RD STE 100, FARMINGTON HILLS, MI 48334-5312
(857) 498-0814
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
3943-MH-B1
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110026265E
—
MA
Enumeration date
08/16/2018
Last updated
04/18/2024
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