Individual
GRACEMARIE FONG LOUIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAT, ATR-BC
Contact information
Practice address
1527 5TH ST, WEST BABYLON, NY 11704-4541
(631) 867-2501
Mailing address
25 NEWTOWN RD, HAMPTON BAYS, NY 11946-1910
(516) 361-4837
Taxonomy
Speciality
Code
Description
License number
State
221700000X
Art Therapist
Primary
—
NY
Other
Enumeration date
10/26/2021
Last updated
10/26/2021
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