Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003126921 |
---|---|
Provider Name | Glorimar Gonzalez-Raices |
First Address | Cambridge, MA 02140-1828 |
Second Address | Cambridge, MA 02140-1828 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2010 |
Last Update Date | 01/12/2010 |