Individual
NICOLE MARDAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5440 74TH ST, ELMHURST, NY 11373-4702
(000) 000-0000
Mailing address
5440 74TH ST, ELMHURST, NY 11373-4702
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
103TS0200X
School Psychologist
—
—
Other
Enumeration date
12/30/2015
Last updated
06/14/2021
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