Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | 394963 | NY |
NPI | 1144801549 |
---|---|
Provider Name | Webster J Ballard |
First Address | Bronx, NY 10473-1506 |
Second Address | Bronx, NY 10473-1506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2021 |
Last Update Date | 16/04/2021 |