Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | 3475897 | MA |
NPI | 1104343615 |
---|---|
Provider Name | Patrice Fong |
First Address | Weymouth, MA 02189-1253 |
Second Address | Braintree, MA 02184-4764 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2017 |
Last Update Date | 17/03/2018 |