Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003242629 |
---|---|
Provider Name | Mr. Kevfoy Lenroy Fletcher |
First Address | Elmont, NY 11003-1414 |
Second Address | Smithtown, NY 11787-3739 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2013 |
Last Update Date | 16/09/2013 |