Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | 5149 | CT |
NPI | 1164182853 |
---|---|
Provider Name | Ana Virginia Taveras |
First Address | Bridgeport, CT 06605-2602 |
Second Address | Bridgeport, CT 06605-1116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2021 |
Last Update Date | 22/12/2021 |