Individual
EMILY ILLESCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
220 13TH ST, BROOKLYN, NY 11215-4802
(718) 630-7942
Mailing address
4 VAILSBURG TER, NEWARK, NJ 07106-2211
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/14/2023
Last updated
07/14/2023
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