Individual
SAMUEL IGBAFE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
685 RIVER AVE, LAKEWOOD, NJ 08701-5288
(888) 400-7342
(732) 534-8629
Mailing address
4292 MARLY GARDEN LN APT 404, FAIRFAX, VA 22033-6409
(804) 300-7923
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-123715
VA
Other
Enumeration date
09/07/2020
Last updated
09/07/2020
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