Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 6427 | MA |
NPI | 1003054362 |
---|---|
Provider Name | Mrs. Neena Nicole Mcconnico |
First Address | Brockton, MA 02302-2336 |
Second Address | Brockton, MA 02302-2336 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2009 |
Last Update Date | 25/01/2009 |