Individual
CONRADO DE LA GARZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11 FARBER DR, UNIT D, BELLPORT, NY 11713-1500
(631) 286-0700
Mailing address
11 FARBER DR, UNIT D, BELLPORT, NY 11713-1500
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
22725
NY
Other
Enumeration date
11/06/2008
Last updated
11/06/2008
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