Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1043702574 |
---|---|
Provider Name | Miss Gwendolyn Miller |
First Address | Bronx, NY 10458-4003 |
Second Address | New York, NY 10026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2018 |
Last Update Date | 31/05/2018 |