Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | P92562 | NY |
NPI | 1003201583 |
---|---|
Provider Name | Jeremy Boyce |
First Address | Albany, NY 12208-3103 |
Second Address | Albany, NY 12209-1543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2015 |
Last Update Date | 01/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
55308A | (02) | NY |
555793 | (05) | NY |