Individual
KASSIDY SANDY-BOURNE
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
(613) 385-7795
Mailing address
225 BROADHOLLOW RD STE 205, MELVILLE, NY 11747-4822
(631) 385-7780
(631) 385-7795
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/28/2018
Last updated
07/09/2021
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