Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
Y | 104100000X | Social Worker |
NPI | 1073994257 |
---|---|
Provider Name | Jennifer Kiel |
First Address | Worcester, MA 01608-1500 |
Second Address | Worcester, MA 01608-1500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2015 |
Last Update Date | 14/06/2015 |