Individual
AMANDA AZORTIBAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
109 OAK ST STE G20, NEWTON, MA 02464-1492
(617) 658-5611
Mailing address
109 OAK ST STE G20, NEWTON, MA 02464-1492
(617) 658-5611
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/18/2022
Last updated
11/18/2022
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