Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | NY |
NPI | 1003450479 |
---|---|
Provider Name | Nicole Marie Corvaia |
First Address | Smithtown, NY 11787-2879 |
Second Address | Smithtown, NY 11787-2879 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2019 |
Last Update Date | 29/10/2019 |