Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | NY |
NPI | 1063777597 |
---|---|
Provider Name | Alicia Adams |
First Address | Brooklyn, NY 11235-3973 |
Second Address | Brooklyn, NY 11235-3973 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2012 |
Last Update Date | 10/07/2012 |