Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003259482 |
---|---|
Provider Name | Dr. Boris Schafer |
First Address | Philadelphia, PA 19134-2328 |
Second Address | Philadelphia, PA 19134-2328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2013 |
Last Update Date | 16/04/2013 |