Individual
MISS MICHELLE MARY FAZZOLARI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS ED.
Contact information
Practice address
436 WILLIS AVE, WILLISTON PARK, NY 11596-2298
(516) 233-0144
Mailing address
436 WILLIS AVE, WILLISTON PARK, NY 11596-2298
(516) 233-0144
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
473873369
NY
174400000X
Specialist
473873369
NY
Other
Enumeration date
08/30/2013
Last updated
08/30/2013
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