Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | PC002571 | PA |
NPI | 1083748628 |
---|---|
Provider Name | Mr. William Robert Smith SR. |
First Address | Catasauqua, PA 18032-1409 |
Second Address | Bethlehem, PA 18018-6505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 08/07/2007 |