Individual
KERISSA LEE TABONA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC-T
Contact information
Practice address
460 BRIELLE AVE, STATEN ISLAND, NY 10314-6427
(718) 356-5100
Mailing address
460 BRIELLE AVE, STATEN ISLAND, NY 10314-6427
(718) 356-5100
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
APPL-098579
NY
Other
Enumeration date
01/30/2025
Last updated
01/30/2025
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