Individual
MRS. GWENDOLYN BURRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
20 GILBERT AVENUE, SUITE 107-A, SMITHTOWN, NY 11787
(631) 901-2052
Mailing address
P.O. BOX 296, NESCONSET, NY 11767-0296
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/04/2020
Last updated
11/04/2020
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