Individual
SHOSHANNAH BETH JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1902 149TH ST, WHITESTONE, NY 11357-3116
(516) 780-0770
(718) 764-1238
Mailing address
60 SENIX AVE, CENTER MORICHES, NY 11934-2905
(631) 767-2146
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/03/2020
Last updated
11/03/2020
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