Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | BH003193 | PA |
NPI | 1003323841 |
---|---|
Provider Name | Tanja Theresia Soto |
First Address | Laureldale, PA 19605-2712 |
Second Address | Wyomissing, PA 19610-2100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2018 |
Last Update Date | 02/01/2018 |