Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | NY |
NPI | 1023561917 |
---|---|
Provider Name | Jonathan Stockford |
First Address | Brooklyn, NY 11238-5343 |
Second Address | Brooklyn, NY 11238-5343 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2016 |
Last Update Date | 27/07/2016 |