Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 101YS0200X | School Counselor | MA |
NPI | 1245813500 |
---|---|
Provider Name | Melanie Banks |
First Address | Boston, MA 02114-2545 |
Second Address | Boston, MA 02114-2545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2021 |
Last Update Date | 04/05/2021 |