Individual
NICOLE JANINE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS STUDENTS WITH DIS
Contact information
Practice address
1787 VILLAGE LN N, WANTAGH, NY 11793-3228
(516) 809-6866
Mailing address
1787 VILLAGE LN N, WANTAGH, NY 11793-3228
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1106362
NY
Other
Enumeration date
09/02/2014
Last updated
09/02/2014
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