Individual
MR. JOHN INNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
52 BROADWAY, SMITHTOWN, NY 11787-4602
(516) 319-2773
Mailing address
52 BROADWAY, SMITHTOWN, NY 11787-4602
(516) 319-2773
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
000089
NY
Other
Enumeration date
10/23/2014
Last updated
10/23/2014
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