Individual
MICHELLE DAZLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7000 AUSTIN ST STE 200, FOREST HILLS, NY 11375-4739
(718) 762-7633
(718) 886-8694
Mailing address
151 E PROSPECT AVE APT 3C, MOUNT VERNON, NY 10550-2232
(914) 513-1020
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/25/2017
Last updated
08/25/2017
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