Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | 00108375 | NY |
NPI | 1275187783 |
---|---|
Provider Name | Ms. Susan John |
First Address | Bronx, NY 10456-6704 |
Second Address | Bronx, NY 10456-6704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2019 |
Last Update Date | 01/08/2019 |