Individual
JENESIA MCCAMMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3321 AVENUE M, BROOKLYN, NY 11210-5421
(718) 531-1800
Mailing address
3321 AVENUE M, BROOKLYN, NY 11210-5421
(718) 531-1800
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
982847151
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
KN70703N
—
NY
Enumeration date
10/06/2015
Last updated
10/06/2015
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