Individual
MRS. PETAGAYE SIMONE TOWNSEND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, BCBA, LBA
Contact information
Practice address
8480 BALTIMORE NATIONAL PIKE STE 3210 #126, ELLICOTT CITY, MD 21043
(914) 363-8313
Mailing address
8480 BALTIMORE NATIONAL PIKE STE 3210 #126, ELLICOTT CITY, MD 21043-1420
(914) 363-8313
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-14-9454
NY
222Q00000X
Developmental Therapist
1125719
NY
Other
Enumeration date
01/14/2012
Last updated
04/30/2021
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