Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | RN2289027 | MA |
NPI | 1003241266 |
---|---|
Provider Name | Cassandra Mary Martin |
First Address | Little Compton, RI 02837-1507 |
Second Address | Fall River, MA 02720-2983 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2013 |
Last Update Date | 06/09/2013 |