Individual
ERICA ALLISON KHOUNSOMBATH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8 FANEUIL HALL MARKETPLACE FL 3, BOSTON, MA 02109-6114
(888) 329-4535
Mailing address
23 BOTANY BAY RD APT 7, WORCESTER, MA 01602-3484
(508) 843-2618
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
MA
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
08/10/2018
Last updated
08/10/2018
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