Individual
MECHELLE MUTKOSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
24 WHEELER PL, NORTHPORT, NY 11768-3146
(631) 651-8904
Mailing address
24 WHEELER PL, NORTHPORT, NY 11768-3146
(631) 651-8904
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
01/15/2015
Last updated
01/15/2015
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