Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor |
NPI | 1215562434 |
---|---|
Provider Name | Ms. Immacula Berrouet |
First Address | Baldwin, NY 11510-3303 |
Second Address | New Hyde Park, NY 11040-1429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2020 |
Last Update Date | 09/03/2020 |