Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003110123 |
---|---|
Provider Name | Jill Marion |
First Address | Pittsfield, MA 01202-4219 |
Second Address | Pittsfield, MA 01201-6278 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2011 |
Last Update Date | 04/01/2011 |