Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 13-03-21 | OR |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 30537 | NY |
Y | 101YM0800X | Mental Health Counselor | 006588 | NY |
NPI | 1003103052 |
---|---|
Provider Name | Chase Brad Girvin |
First Address | New York, NY 10010-1600 |
Second Address | Brooklyn, NY 11225-5417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2011 |
Last Update Date | 17/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00695941 | (05) | NY |