Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003214594 |
---|---|
Provider Name | Mr. Thomas Joseph Haitsma |
First Address | New Bedford, MA 02740-2782 |
Second Address | New Bedford, MA 02740-2782 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2014 |
Last Update Date | 15/12/2014 |