Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
Y | 1041C0700X | Clinical Social Worker | 115368 | MA |
NPI | 1043591423 |
---|---|
Provider Name | Victoria A Jones |
First Address | Springfield, MA 01101-5803 |
Second Address | Springfield, MA 01109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2011 |
Last Update Date | 30/08/2011 |