Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
Y | 103G00000X | Clinical Psychologist | 021471 | NY |
Y | 103TC0700X | Clinical Psychologist | 021471 | NY |
N | 103TP2701X | Group Psychotherapist |
NPI | 1447615372 |
---|---|
Provider Name | Dr. Santos Vales |
First Address | Brooklyn, NY 11231-5002 |
Second Address | Brooklyn, NY 11231-5002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2015 |
Last Update Date | 18/12/2015 |