Individual
KELLY BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
35 REVERE RD, QUEENSBURY, NY 12804-8044
(518) 605-3146
Mailing address
35 REVERE RD, QUEENSBURY, NY 12804-8044
(518) 605-3146
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
000993-1
NY
Other
Enumeration date
07/11/2016
Last updated
02/19/2020
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