Individual
AVERILLE BC MALCOLM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6130 217TH ST, BAYSIDE, NY 11364-2234
(917) 362-7309
Mailing address
6130 217TH ST, BAYSIDE, NY 11364-2234
(917) 362-7309
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
113628
NY
Other
Enumeration date
09/09/2021
Last updated
09/09/2021
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