Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YS0200X | School Counselor |
NPI | 1205195930 |
---|---|
Provider Name | Bethanie Sylvia |
First Address | Fairhaven, MA 02719-4705 |
Second Address | New Bedford, MA 02740-6728 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2012 |
Last Update Date | 15/05/2012 |