Individual
JALEESA STATEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1420 WALNUT ST, PHILADELPHIA, PA 19102-4017
(215) 527-6740
Mailing address
2924 N VAN PELT ST, PHILADELPHIA, PA 19132-1506
(215) 239-0843
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/06/2020
Last updated
11/06/2020
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