Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 8252726 | NY |
N | 103TC1900X | Counseling Psychologist | PS-008741-L | PA |
NPI | 1083055354 |
---|---|
Provider Name | Joellen Popma |
First Address | Rochester, NY 14627-0356 |
Second Address | Rochester, NY 14620-3031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2013 |
Last Update Date | 15/07/2013 |