Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 6603 | NY |
NPI | 1003185216 |
---|---|
Provider Name | Mr. Robert Stanley Burch |
First Address | Brooklyn, NY 11236-2213 |
Second Address | Brooklyn, NY 11236-2213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2011 |
Last Update Date | 16/12/2011 |