Individual
GARY HENRIQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
34 LARKIN ST, REVERE, MA 02151-5628
(617) 458-0773
Mailing address
8 ESSEX CENTER DR, PEABODY, MA 01960-2959
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/19/2023
Last updated
01/19/2023
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