Individual
MARIANA FRAGA I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
22777 W 11 MILE RD, SOUTHFIELD, MI 48033-2152
(484) 358-0722
Mailing address
22777 W 11 MILE RD, SOUTHFIELD, MI 48033-2152
(248) 358-0722
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-14-10073
PA
Other
Enumeration date
05/27/2015
Last updated
05/27/2015
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