Individual
FIFA ATEF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
37 HOLSMAN RD, STATEN ISLAND, NY 10301-4426
(929) 867-2287
Mailing address
37 HOLSMAN RD, STATEN ISLAND, NY 10301-4426
(929) 867-2287
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
133V00000X
Registered Dietitian
—
—
Other
Enumeration date
06/17/2024
Last updated
06/17/2024
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