Samantha C Gandolfo
Behavior Technician in Coram, NY. Individual provider (NPI-1).
NPI number1013554161
StatusActive
Last updated in NPPESDec 9, 2019
Details
- NPI
- 1013554161
- Entity type
- Individual (NPI-1)
- Name
- Samantha C Gandolfo
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Dec 9, 2019
- Certification date
- Dec 9, 2019
- Last updated
- Dec 9, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Practice location
1 Corpine LnCoram, NY 11727-2603
Phone 631-809-2153
Mailing address
1 Corpine LnCoram, NY 11727-2603
Phone 631-809-2153
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