Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YP1600X | Pastoral Counselor | ||
Y | 101YP2500X | Professional Counselor |
NPI | 1275873481 |
---|---|
Provider Name | Peter Michael Preble |
First Address | Quincy, MA 02169-4504 |
Second Address | Quincy, MA 02169-4504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2013 |
Last Update Date | 03/06/2016 |