Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003181413 |
---|---|
Provider Name | Leah Kabue |
First Address | Springfield, MA 01108-1119 |
Second Address | Springfield, MA 01109-3517 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2012 |
Last Update Date | 19/03/2012 |