Individual
MISS LARISSA KAVITSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
24 GALE DR, VALLEY STREAM, NY 11581-3623
(516) 592-0582
Mailing address
24 GALE DR, VALLEY STREAM, NY 11581-3623
(516) 592-0582
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
509507977
NY
Other
Enumeration date
02/03/2015
Last updated
02/03/2015
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