Individual
NI MO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
102 SOUTHERN PKWY, PLAINVIEW, NY 11803-3747
(917) 535-9099
Mailing address
102 SOUTHERN PKWY, PLAINVIEW, NY 11803-3747
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
37879
NY
Other
Enumeration date
09/10/2025
Last updated
09/10/2025
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