Individual
MR. MARVIN THEODORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
263 PORT RICHMOND AVE, STATEN ISLAND, NY 10302-1704
(718) 981-8117
Mailing address
263 PORT RICHMOND AVE, STATEN ISLAND, NY 10302-1704
(718) 981-8117
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
33621
NY
Other
Enumeration date
01/02/2018
Last updated
01/02/2018
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