Individual
SAMANTHA R AVILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2 PROSPECT AVE, MIDDLETOWN, NY 10940-4112
(917) 912-8061
Mailing address
2 PROSPECT AVE, MIDDLETOWN, NY 10940-4112
(917) 912-8061
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1333821191
NY
Other
Enumeration date
01/30/2020
Last updated
08/20/2021
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