Individual
AILEEN GONZALVO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
102 WOOD ST, LYNBROOK, NY 11563-2466
(516) 708-3150
Mailing address
102 WOOD ST, LYNBROOK, NY 11563-2466
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-08-4841
NY
174400000X
Specialist
465149101
NY
174400000X
Specialist
626714051
NY
Other
Enumeration date
04/09/2013
Last updated
04/09/2013
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