Individual
SAMPA DAS I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6405 AP 2B WOODSIDE AVE, 4806 59 PL, WOODSIDE, NY 11377
(929) 462-9072
Mailing address
64- 05 WOODSIDE AVE AP 2 B, 64-05 WOODSIDE AVE AP 2B, WOODSIDE, NY 11377
(929) 462-9072
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
NY
Other
Enumeration date
03/15/2023
Last updated
03/15/2023
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