Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 120255 | MA |
NPI | 1003207713 |
---|---|
Provider Name | Susanna Sylvia |
First Address | Fall River, MA 02720-6009 |
Second Address | Fall River, MA 02720-6009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2015 |
Last Update Date | 27/02/2017 |