Individual
NIA STATION
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
212 2ND ST STE 202A, LAKEWOOD, NJ 08701-3951
(402) 252-1363
Mailing address
212 2ND ST STE 202A, LAKEWOOD, NJ 08701-3951
(402) 252-1363
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-185042
NE
Other
Enumeration date
10/01/2021
Last updated
10/01/2021
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