Individual
LIVIA EVANGELISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
110 GEORGIA AVE, LONG BEACH, NY 11561-1238
(917) 399-4121
Mailing address
110 GEORGIA AVE, LONG BEACH, NY 11561-1238
(917) 399-4121
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
009050
NY
Other
Enumeration date
02/10/2017
Last updated
02/10/2017
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