Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003421553 |
---|---|
Provider Name | Cristy Soraida Eligio |
First Address | Bronx, NY 10451-5416 |
Second Address | Bronx, NY 10451-5416 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2020 |
Last Update Date | 11/09/2020 |