Most Relevant Information
Provider Data
| NPI Number: | 1003555962 |
| Provider Name: | MIESHA JOY BOOTH |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/31/2022 |
| Last Updated: | 05/31/2022 |
Provider Practice Location
400 E PRATT ST FL 8
BALTIMORE
MD
212023180
Practice Location Phone/Fax
| Phone: | 8335992560 |
| Fax: |
Provider Mailing Location
850 TOWBIN AVE
LAKEWOOD
NJ
087015928
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |