Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YS0200X | School Counselor | 512573 | MA |
Y | 1041S0200X | School Social Worker | 512573 | MA |
NPI | 1033744396 |
---|---|
Provider Name | Bianca Genualdo |
First Address | Peabody, MA 01960-3544 |
Second Address | Roslindale, MA 02131-3908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2020 |
Last Update Date | 13/03/2020 |