Individual
CARLY PATRICE RIECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSED
Contact information
Practice address
405 AVALON PINES DR, CORAM, NY 11727-5129
(646) 912-0874
Mailing address
405 AVALON PINES DR, CORAM, NY 11727-5129
(646) 912-0874
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
364369091
NY
Other
Enumeration date
09/28/2021
Last updated
09/28/2021
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