Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 30549 | NY |
NPI | 1003478496 |
---|---|
Provider Name | Megan Gellman |
First Address | Jamaica, NY 11434-1527 |
Second Address | Jamaica, NY 11434-1527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2019 |
Last Update Date | 08/05/2020 |