Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YP1600X | Pastoral Counselor |
NPI | 1255949715 |
---|---|
Provider Name | Mr. Adam Sherblom |
First Address | Holden, MA 01520-1208 |
Second Address | Holden, MA 01520-1208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2020 |
Last Update Date | 21/07/2020 |