Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003363094 |
---|---|
Provider Name | Der-Yi Li |
First Address | Quincy, MA 02169-4313 |
Second Address | Quincy, MA 02169-4313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2016 |
Last Update Date | 06/11/2019 |