Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003293457 |
---|---|
Provider Name | Mr. Ryan Spina |
First Address | Jamaica Plain, MA 02130-2704 |
Second Address | Jamaica Plain, MA 02130-2704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2015 |
Last Update Date | 05/05/2015 |