Individual
TANYA NADENE CLARKE CARRASCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
221 ATLANTIC AVE, FREEPORT, NY 11520-4924
(646) 303-8750
Mailing address
221 ATLANTIC AVE, FREEPORT, NY 11520-4924
(646) 303-8750
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
NY
Other
Enumeration date
08/29/2018
Last updated
08/29/2018
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