Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 101YS0200X | School Counselor |
NPI | 1053934323 |
---|---|
Provider Name | Audrey Grubb |
First Address | Boston, MA 02215-5200 |
Second Address | Taunton, MA 02780-3243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2020 |
Last Update Date | 21/05/2020 |