Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003001223 |
---|---|
Provider Name | Myco Foy |
First Address | Waterbury, CT 06702-2310 |
Second Address | Waterbury, CT 06702-2310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2007 |
Last Update Date | 17/02/2017 |