Individual
DIANE BROUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A. SPECIAL ED
Contact information
Practice address
854 E BROADWAY APT 7H, LONG BEACH, NY 11561-4733
(516) 897-0412
Mailing address
854 E BROADWAY, APT 7H, LONG BEACH, NY 11561-4758
(516) 287-7084
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103K00000X
EDUCATIONAL AGENCY
NY
Enumeration date
10/29/2015
Last updated
10/29/2015
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