Individual
MICHAEL JONATHAN PASSAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
246 W UPSAL ST, A202, PHILADELPHIA, PA 19119-3264
(862) 202-1516
Mailing address
246 W UPSAL ST, A202, PHILADELPHIA, PA 19119-3264
(862) 202-1516
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BH002606
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-14-16814
BCBA
—
Enumeration date
06/09/2015
Last updated
06/09/2015
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