Individual
TIFFANY GONSALVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS.ED
Contact information
Practice address
603 E 83RD ST, BROOKLYN, NY 11236-3435
(212) 300-5001
Mailing address
603 E 83RD ST, BROOKLYN, NY 11236-3435
(212) 300-5001
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
1001236151
NY
Other
Enumeration date
01/21/2016
Last updated
01/21/2016
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