Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health |
NPI | 1932639507 |
---|---|
Provider Name | Ximar Carrillo |
First Address | Springfield, MA 01104-2038 |
Second Address | Springfield, MA 01104-2038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2017 |
Last Update Date | 05/10/2017 |