Individual
MR. BLAINE DUVAL GIBBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ABA THERAPIST
Contact information
Practice address
329 E 149TH ST FL 4, BRONX, NY 10451-5626
(718) 769-2698
Mailing address
1135 UNIVERSITY AVE APT 1F, BRONX, NY 10452-4236
(646) 837-4005
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
NY
Other
Enumeration date
07/27/2017
Last updated
07/27/2017
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