Individual
MRS. GINA MARIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS.ED., BCBA/LABA
Contact information
Practice address
34 SALINA RD, DORCHESTER, MA 02122-3314
(617) 513-6566
Mailing address
34 SALINA RD, DORCHESTER, MA 02122-3314
(617) 513-6566
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
405
MA
Other
Enumeration date
03/30/2017
Last updated
03/30/2017
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