Individual
LATISHA BRACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10818 QUEENS BLVD STE 4A5TH, FOREST HILLS, NY 11375-4748
(212) 804-7659
Mailing address
10818 QUEENS BLVD STE 4A5TH, FOREST HILLS, NY 11375-4748
(212) 804-7659
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/13/2018
Last updated
03/13/2018
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