Individual
KEELY BACKUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1649 61ST STREET, ST 301, BROOKLYN, NY 11204-3319
(000) 000-0000
Mailing address
1649 61ST STREET, ST 301, BROOKLYN, NY 11204-3319
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
156AN5828
IA
Other
Enumeration date
04/12/2025
Last updated
04/17/2025
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