Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 006374-1 | NY |
NPI | 1760854897 |
---|---|
Provider Name | Jennifer Noecker |
First Address | Utica, NY 13502-3854 |
Second Address | Utica, NY 13502-3854 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2015 |
Last Update Date | 28/10/2015 |