Individual
LELA BLACK MADFIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
50 DONALD B DEAN DR STE B, SOUTH PORTLAND, ME 04106-3373
(207) 274-2528
Mailing address
21600 OXNARD ST STE 1800, WOODLAND HILLS, CA 91367-7807
(818) 345-2345
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/01/2021
Last updated
03/15/2021
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