Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 007495 | NY |
N | 101YP1600X | Pastoral Counselor |
NPI | 1255866141 |
---|---|
Provider Name | Serop Terterian |
First Address | New Hyde Park, NY 11040-3818 |
Second Address | New Hyde Park, NY 11040-3818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2017 |
Last Update Date | 27/04/2017 |