Individual
RUSSELL JOHANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6 BRADLEY DR, SHOREHAM, NY 11786-2328
(631) 384-3154
Mailing address
6 BRADLEY DR, SHOREHAM, NY 11786-2328
(631) 384-3154
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
07/14/2022
Last updated
07/14/2022
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