Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003108788 |
---|---|
Provider Name | Ms. Vanessa Joan Roy |
First Address | Brighton, MA 02135-6236 |
Second Address | Lawrence, MA 01843-2837 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2011 |
Last Update Date | 12/05/2011 |