Individual
MRS. KRYSTAL ROSE MARIE ELLSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6214 24TH AVE, BROOKLYN, NY 11204-3319
(000) 000-0000
Mailing address
6214 24TH AVE, BROOKLYN, NY 11204-3319
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
106S00000X
KS
Other
Enumeration date
04/26/2024
Last updated
04/26/2024
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