Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1124793070 |
---|---|
Provider Name | Alfakelis Liz |
First Address | Woodland Park, NJ 07424-3128 |
Second Address | Woodland Park, NJ 07424-3128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2021 |
Last Update Date | 12/08/2021 |