Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1083382014 |
---|---|
Provider Name | Mr. Jose Luis De Ramon III |
First Address | Chestnut Hill, MA 02467-3638 |
Second Address | Boston, MA 02128-2335 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2021 |
Last Update Date | 03/09/2021 |