Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YS0200X | School Counselor | 1023013 | MA |
Y | 1041S0200X | School Social Worker | 1023013 | MA |
NPI | 1184184806 |
---|---|
Provider Name | Jessica Flora Grill |
First Address | Arlington, MA 02474-8903 |
Second Address | Bedford, MA 01730-1404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2019 |
Last Update Date | 20/03/2019 |