Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003498791 |
---|---|
Provider Name | Pamela Cummisky |
First Address | New Bedford, MA 02740-7321 |
Second Address | Brockton, MA 02301-7122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2021 |
Last Update Date | 22/04/2021 |