Individual
DESTINY HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
225 BROADHOLLOW RD STE 402, MELVILLE, NY 11747-4899
(631) 385-7780
Mailing address
105 BARUCH DR APT 9C, NEW YORK, NY 10002-3613
(646) 938-5391
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
NY
Other
Enumeration date
05/05/2019
Last updated
05/05/2019
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