Individual
STACEY CRIVELLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
87 INDIAN HEAD RD, KINGS PARK, NY 11754-4401
(631) 387-2627
Mailing address
87 INDIAN HEAD RD, KINGS PARK, NY 11754-4401
(631) 387-2627
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
NY
252Y00000X
Early Intervention Provider Agency
Primary
—
NY
Other
Enumeration date
06/03/2018
Last updated
06/03/2018
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