Individual
JUDITH L CONKLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC
Contact information
Practice address
9729 64TH RD, REGO PARK, NY 11374-2240
(718) 896-3400
(718) 459-5621
Mailing address
5503 68TH ST, MASPETH, NY 11378-1836
(718) 505-1492
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
4347
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00244019
—
NY
Enumeration date
05/14/2008
Last updated
05/14/2008
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