Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1043876840 |
---|---|
Provider Name | Mr. Jose Angel Tavares JR. |
First Address | Allentown, PA 18102-4339 |
Second Address | Allentown, PA 18102-4339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2019 |
Last Update Date | 16/05/2019 |