Individual
MACKENZIE ANN BRUNQUELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
811 W JERICHO TPKE STE 106E, SMITHTOWN, NY 11787-3220
(631) 306-4284
Mailing address
6 EMERALD ST, LAKE RONKONKOMA, NY 11779-2700
(631) 560-4005
Taxonomy
Speciality
Code
Description
License number
State
221700000X
Art Therapist
Primary
—
—
Other
Enumeration date
07/12/2022
Last updated
07/12/2022
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