Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YM0800X | Mental Health Counselor | 006776-1 | NY |
NPI | 1003196908 |
---|---|
Provider Name | Priya Mittal |
First Address | Tomkins Cove, NY 10986-1028 |
Second Address | Nanuet, NY 10954-2955 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2011 |
Last Update Date | 09/01/2017 |