Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003176330 |
---|---|
Provider Name | Daniel Sullivan |
First Address | Pittsfield, MA 01201-5261 |
Second Address | Pittsfield, MA 01201-5261 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2012 |
Last Update Date | 21/05/2012 |