Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 000862 | CT |
Y | 104100000X | Social Worker |
NPI | 1003309402 |
---|---|
Provider Name | Sylvester Esangbedo |
First Address | Windsor, CT 06095-1722 |
Second Address | Manchester, CT 06040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2018 |
Last Update Date | 02/08/2018 |