Individual
KIARA YSSEL REVILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10 PARSONAGE RD STE 318, EDISON, NJ 08837-2429
(732) 204-1635
(732) 204-1636
Mailing address
149 EDMUND AVE, PATERSON, NJ 07502-2050
(973) 356-5010
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/30/2018
Last updated
10/30/2018
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