Individual
ALEXA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
118 KETAY DR S, EAST NORTHPORT, NY 11731-5014
(631) 275-6131
Mailing address
118 KETAY DRIVE SOUTH, EAST NORTHPORT, NY 11731
(631) 275-6131
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/28/2017
Last updated
04/28/2017
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