Individual
AUDREY CRUCETTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
147 TOWN LINE RD, WEST CHAZY, NY 12992-3931
(518) 420-3443
Mailing address
147 TOWN LINE RD, WEST CHAZY, NY 12992-3931
(518) 420-3443
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
000083
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000083
NEW YORK STATE
NY
Enumeration date
11/02/2015
Last updated
11/02/2015
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