Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003116245 |
---|---|
Provider Name | Ms. Jeanette Alicea |
First Address | West Springfield, MA 01089-5003 |
Second Address | Springfield, MA 01103-2203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2010 |
Last Update Date | 21/10/2010 |