Individual
ETHAN WARDLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2631 MERRICK RD, SUITE 202, BELLMORE, NY 11710-5730
(646) 327-2723
Mailing address
266 NASSAU AVE, APT 1R, BROOKLYN, NY 11222-4770
(714) 357-3184
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
08/13/2014
Last updated
08/13/2014
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