Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 101YS0200X | School Counselor |
NPI | 1144842881 |
---|---|
Provider Name | Jacelyn Diaz |
First Address | Holyoke, MA 01040-3968 |
Second Address | Holyoke, MA 01040-3968 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2020 |
Last Update Date | 16/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
042174657 | (05) | MA |