Individual
EBONY PORTIA BRANCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7 ARMORY ST APT 3, SPRINGFIELD, MA 01105-1020
(141) 320-9640
Mailing address
7 ARMORY ST, SPRINGFIELD, MA 01105-1020
(413) 209-6407
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
KEY AUTISM SERVICE
—
Enumeration date
10/16/2018
Last updated
10/16/2018
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