Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YP1600X | Pastoral Counselor |
NPI | 1154666204 |
---|---|
Provider Name | Mr. Robert M Foote |
First Address | Ithaca, NY 14850-5635 |
Second Address | Ithaca, NY 14850-5635 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2012 |
Last Update Date | 30/11/2012 |