Individual
THERESA PANICCIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1595 LEXINGTON AVE, 5C, NEW YORK, NY 10029-6298
(321) 960-6470
Mailing address
1595 LEXINGTON AVE, 5C, NEW YORK, NY 10029-6298
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
04/22/2016
Last updated
04/22/2016
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