Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-12-10407 | NY |
NPI | 1013271634 |
---|---|
Provider Name | Mrs. Heather Ann Shook |
First Address | West Babylon, NY 11704-7336 |
Second Address | Garden City, NY 11530-3302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2012 |
Last Update Date | 28/06/2012 |