Individual
DEMI V DACOSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4624 BROADWAY, NEW YORK, NY 10040-2102
(212) 569-1044
Mailing address
164 MAUJER ST APT 3B, BROOKLYN, NY 11206-1347
(917) 213-0390
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
—
—
Other
Enumeration date
10/05/2024
Last updated
10/05/2024
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