Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YP1600X | Pastoral Counselor |
NPI | 1033545611 |
---|---|
Provider Name | Dody Star Siegfried |
First Address | Easton, PENNSYLVANIA 18045 |
Second Address | Bangor, PA 18013-1901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2013 |
Last Update Date | 16/09/2013 |