Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 22573 | NY |
NPI | 1003129776 |
---|---|
Provider Name | Mrs. Becky Allen |
First Address | Bronx, NY 10454 |
Second Address | Bronx, NY 10454 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2010 |
Last Update Date | 22/07/2010 |