Individual
MARISSA MACCULLOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
49 COLUMBIA ST, BETHPAGE, NY 11714-5112
(516) 319-3316
Mailing address
49 COLUMBIA ST, BETHPAGE, NY 11714-5112
(516) 319-3316
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
07/23/2014
Last updated
07/23/2014
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