Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 3090 |
NPI | 1316455876 |
---|---|
Provider Name | Hillary Rea Bercovici |
First Address | Greenwich, CT 06830 |
Second Address | Greenwich, CT 06830 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2018 |
Last Update Date | 18/01/2018 |