Individual
MYAN DASCO CELEBRADO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10529 63RD RD, FOREST HILLS, NY 11375-1348
(347) 466-8793
Mailing address
10529 63RD RD, FOREST HILLS, NY 11375-1348
(347) 466-8793
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-80111
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
639851125
LEARNER PERMIT
NY
Enumeration date
04/13/2019
Last updated
04/13/2019
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