Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 216014 | MA |
NPI | 1003047945 |
---|---|
Provider Name | Mr. Timothy Roy |
First Address | Boston, MA 02131-3908 |
Second Address | Boston, MA 02131-3908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2009 |
Last Update Date | 01/06/2010 |