Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003001496 |
---|---|
Provider Name | Luis Sostre JR. |
First Address | Springfield, MA 01105-2506 |
Second Address | Springfield, MA 01105-2506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2007 |
Last Update Date | 14/12/2016 |