Individual
GARY FORTUNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
373 S WILLOW ST STE 266, MANCHESTER, NH 03103-5751
(877) 315-8080
Mailing address
373 S WILLOW ST STE 266, MANCHESTER, NH 03103-5751
(877) 315-8080
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-18-70933
REGISTERED BEHAVIOR TECHNICIAN
FL
Enumeration date
11/19/2018
Last updated
12/01/2019
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