Individual
BRENDA ERIN LARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1110 SOUTH AVE STE 405, STATEN ISLAND, NY 10314-3414
(718) 556-1616
Mailing address
9013 83RD AVE, GLENDALE, NY 11385-7815
(718) 928-8645
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
2720876
NY
Other
Enumeration date
01/29/2020
Last updated
01/29/2020
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