Individual
JUSTINE MARIE KOO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
1600 DEER PARK AVE, DEER PARK, NY 11729-5208
(631) 242-2250
Mailing address
1600 DEER PARK AVE, DEER PARK, NY 11729-5208
(631) 242-2250
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
023472
NY
Other
Enumeration date
10/11/2019
Last updated
10/11/2019
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