Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003211830 |
---|---|
Provider Name | Marissa Josub |
First Address | Whately, MA 01039 |
Second Address | Edwards, CO 81632-6433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2014 |
Last Update Date | 14/02/2022 |