Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 083303 | NY |
N | 103TC1900X | Counseling Psychologist | 083303 | NY |
Y | 104100000X | Social Worker | 083303 | NY |
N | 1041C0700X | Clinical Social Worker | 086100 | NY |
NPI | 1174806442 |
---|---|
Provider Name | Mr. Timmy J.k. So |
First Address | Niagra Falls, NY 14301 |
Second Address | Buffalo, NY 14215-3098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2011 |
Last Update Date | 08/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00932467 | (05) | NY |