Individual
MR. VLADIMIR JUNIOR GENAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, BCBA, LABA
Contact information
Practice address
607 NORTH AVE, DOOR 11, WAKEFIELD, MA 01880
(866) 926-4345
Mailing address
15 ROBINSON ST FL 2, LYNN, MA 01905-1813
(781) 913-8512
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106E00000X
Assistant Behavior Analyst
2629
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2629
LABA
MA
Enumeration date
04/02/2019
Last updated
01/03/2022
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