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Individual

DR. SALLY MICHELLE IZQUIERDO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHD, BCBA-D, LBA, LP

Contact information

Practice address
177 RANDALL RD, SHOREHAM, NY 11786-2341
(631) 317-0025
Mailing address
177 RANDALL RD, SHOREHAM, NY 11786-2341
(631) 317-0025

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
000446-1
NY
103T00000X
Psychologist
026348
NY

Other

Enumeration date
12/17/2018
Last updated
09/23/2024
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