Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003170705 |
---|---|
Provider Name | Miss Andrene Latoya Scarlett |
First Address | Worcester, MA 01602-3441 |
Second Address | Worcester, MA 01602-3441 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2012 |
Last Update Date | 27/06/2012 |