Individual
AIDA IBANEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
780 AMERICAN LEGION HWY, ROSLINDALE, MA 02131-3908
(617) 469-8500
Mailing address
780 AMERICAN LEGION HWY, ROSLINDALE, MA 02131-3908
(617) 469-8500
Taxonomy
Speciality
Code
Description
License number
State
101YS0200X
School Counselor
Primary
—
—
103K00000X
Behavior Analyst
—
—
Other
Enumeration date
01/08/2019
Last updated
10/26/2021
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