Individual
BRENDAN EVANICKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2521 TIEMANN AVE, BRONX, NY 10469-6146
(646) 764-0646
Mailing address
2521 TIEMANN AVE, BRONX, NY 10469-6146
(646) 764-0646
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/15/2024
Last updated
07/15/2024
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