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1700393527
MARVIN THEODORE
STATEN ISLAND, NY
NPI
1700393527
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: NY 33621)
Enumeration Date
2018-01-02
Last Update Date
2018-01-02
Business Address
Mr. MARVIN THEODORE
263 PORT RICHMOND AVE
STATEN ISLAND, NY 10302-1704
Phone number: 718-981-8117
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Mailing Address
Mr. MARVIN THEODORE
263 PORT RICHMOND AVE
STATEN ISLAND, NY 10302-1704
Phone number: 718-981-8117
Copy
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