Individual
CORI WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2631 MERRICK RD STE 302, BELLMORE, NY 11710-5784
(516) 590-7573
Mailing address
311 E 93RD ST APT 3S, NEW YORK, NY 10128-6123
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
08/24/2017
Last updated
08/24/2017
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