Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 001341 | CT |
NPI | 1003098377 |
---|---|
Provider Name | Mr. Alex Boianghu |
First Address | Ridgefield, CT 06877-4105 |
Second Address | Ridgefield, CT 06877-4105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2007 |
Last Update Date | 28/11/2007 |