Individual
JENNIFER PAOLA CHACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
225 BROADHOLLOW RD STE 402, MELVILLE, NY 11747-4899
(631) 385-7780
(631) 385-7795
Mailing address
4115 45TH ST APT 1F, SUNNYSIDE, NY 11104-1924
(347) 988-1445
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/20/2018
Last updated
02/20/2018
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