Individual
SISSY L VILLAMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
358 SAINT MARKS PL FL 4, STATEN ISLAND, NY 10301-2417
(646) 342-2742
Mailing address
358 SAINT MARKS PL FL 4, STATEN ISLAND, NY 10301-2417
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
378902972
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
378902972
DRIVER LICENSE
NY
Enumeration date
01/06/2020
Last updated
01/06/2020
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