Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 1607 | MA |
NPI | 1033263074 |
---|---|
Provider Name | Mr. Joel David Covitz |
First Address | Brookline, MA 02446-4006 |
Second Address | Brookline, MA 02446-4006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |