Individual
JAKE NATHAN WOLFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14 MUD RD, SETAUKET, NY 11733-1410
(516) 662-4063
Mailing address
14 MUD RD, SETAUKET, NY 11733-1410
(516) 662-4063
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/09/2024
Last updated
07/09/2024
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