Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003131780 |
---|---|
Provider Name | Theresa Renee Albert-Dejesus |
First Address | Roxbury, MA 02119-1444 |
Second Address | Roxbury, MA 02119-1444 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2010 |
Last Update Date | 06/04/2010 |