Individual
EBONY LISANA LUCA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
170 WALKER ST, WEST BABYLON, NY 11704-3415
(516) 819-8422
Mailing address
170 WALKER ST, WEST BABYLON, NY 11704-3415
(516) 819-8422
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/21/2022
Last updated
01/21/2022
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