Individual
MRS. JEANINE DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4 KENSINGTON AVE, MASSAPEQUA, NY 11758-6132
(516) 650-9504
Mailing address
4 KENSINGTON AVE, MASSAPEQUA, NY 11758-6132
(516) 650-9504
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/06/2017
Last updated
03/06/2017
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