Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1063894327 |
---|---|
Provider Name | Dr. Breanna Masi |
First Address | Bohemia, NY 11716-4936 |
Second Address | Bohemia, NY 11716-3604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2015 |
Last Update Date | 06/10/2016 |