Individual
MRS. JESSICA BETH BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
42 GWENDOLYN PL, EAST ISLIP, NY 11730-3220
(631) 525-3202
Mailing address
42 GWENDOLYN PL, EAST ISLIP, NY 11730-3220
(631) 525-3202
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
NY
Other
Enumeration date
06/04/2019
Last updated
06/04/2019
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