Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 228947 | NY |
NPI | 1003312638 |
---|---|
Provider Name | Clifford William Rice |
First Address | Long Island City, NY 11101-2829 |
Second Address | Long Island City, NY 11101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2018 |
Last Update Date | 03/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02740141 | (05) | NY |