Individual
MISS ANDREA CHRISTINE THEMISTOCLEOUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSED, BCBA
Contact information
Practice address
86 SMITH LN, CENTEREACH, NY 11720-3874
(917) 602-4103
Mailing address
86 SMITH LN, CENTEREACH, NY 11720-3874
(917) 602-4103
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1-07-3692
NY
174400000X
Specialist
Primary
1752785
NY
Other
Enumeration date
06/12/2012
Last updated
06/12/2012
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