Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003219338 |
---|---|
Provider Name | Ms. Bernice B Tett |
First Address | Philadelphia, PA 19145-2225 |
Second Address | Philadelphia, PA 19145-2225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2014 |
Last Update Date | 02/11/2015 |