Individual
GWENDOLYN GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1434 110TH ST STE 303, COLLEGE POINT, NY 11356-1448
(718) 569-5439
Mailing address
130 OVERLOOK AVE APT 14D, HACKENSACK, NJ 07601-2223
(646) 880-7869
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/02/2021
Last updated
06/02/2021
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