Individual
CARLY GOODMAN BAX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1010 N HANCOCK ST, PHILADELPHIA, PA 19123-2334
(267) 978-4305
Mailing address
1337 MARLBOROUGH ST, PHILADELPHIA, PA 19125-3214
(862) 432-2659
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/19/2021
Last updated
05/19/2021
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