Individual
DEREK SOSNOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
14 PACELLA PARK DR, RANDOLPH, MA 02368-1756
(781) 440-0400
Mailing address
14 PACELLA PARK DR, RANDOLPH, MA 02368-1756
(781) 440-0400
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110026265E
—
MA
Enumeration date
10/21/2016
Last updated
10/21/2016
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