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Individual

SOLINA VAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
80 MOUNT WASHINGTON ST, LOWELL, MA 01854-3422
(978) 710-1469
Mailing address
80 MOUNT WASHINGTON ST, LOWELL, MA 01854-3422
(978) 710-1469

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
S53660171
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
S53660171
DRIVERS LICENSE
MA
Enumeration date
05/30/2019
Last updated
05/30/2019
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