Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 001205 | CT |
NPI | 1003872383 |
---|---|
Provider Name | Mr. Mark C Vanacore |
First Address | Guilford, CT 06437-5000 |
Second Address | New Haven, CT 06511-3923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 08/07/2007 |