Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | XXX | NY |
NPI | 1346234960 |
---|---|
Provider Name | Mrs. Tara B Bremer |
First Address | Delmar, NY 12054-1227 |
Second Address | Delmar, NY 12054-1227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
XXX | PASTORAL COUNSELOR (01) | NY |