Individual
DVORA PHILLIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
22 BAILA BLVD, LAKEWOOD, NJ 08701-1493
(732) 606-5004
Mailing address
40 CHESTNUT ST, LAKEWOOD, NJ 08701-1493
(732) 833-3723
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-15-19791
NJ
103K00000X
Behavior Analyst
—
—
Other
Enumeration date
10/19/2015
Last updated
10/28/2015
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