Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 623146 | NY |
NPI | 1093080053 |
---|---|
Provider Name | Kristy Lynn Brothers |
First Address | Malta, NY 12020-3737 |
Second Address | Malta, NY 12020-3737 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2012 |
Last Update Date | 09/03/2012 |