Individual
ETHAN DEJESUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
113 RICHDALE AVE UNIT 15, CAMBRIDGE, MA 02140-3333
(413) 275-9373
Mailing address
38 N SUMMER ST APT 1B, HOLYOKE, MA 01040-6266
(413) 275-9373
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/12/2024
Last updated
03/12/2024
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