Individual
KAREN DIERS PIDDOUBNY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LBA
Contact information
Practice address
2 ELLEN LN, MANORVILLE, NY 11949-3222
(631) 219-7759
Mailing address
2 ELLEN LN, MANORVILLE, NY 11949-3222
(631) 219-7759
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
001631
NY
Other
Enumeration date
10/27/2019
Last updated
10/27/2019
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