Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 777242 | MA |
NPI | 1942503131 |
---|---|
Provider Name | Denise M Goddard |
First Address | Webster, MA 01570-2262 |
Second Address | Webster, MA 01570-2262 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2010 |
Last Update Date | 10/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
225700000X | IRONWORKERS UNION (01) | MA |