Individual
LISSETTE BORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1110 SOUTH AVE, STATEN ISLAND, NY 10314-3403
(866) 707-8669
Mailing address
918 FOREST AVE, STATEN ISLAND, NY 10310-2413
(917) 805-6610
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
03/01/2021
Last updated
03/01/2021
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