| NPI | 1821188111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NJ 44SC00272300) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NJ 44SC00272300) |
| 101Y00000X Counselor (Licence: MA 2020439) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 44SC00272300) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 2020439) | |
| 101YM0800X Counselor, Mental Health (Licence: MA 2020439) | |
| 101YM0800X Counselor, Mental Health (Licence: NJ 44SC00272300) | |
| 101YP2500X Counselor, Professional (Licence: NJ 44SC00272300) | |
| 101YP2500X Counselor, Professional (Licence: MA 2020439) | |
| 104100000X Social Worker (Licence: MA 2020439) | |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC00272300) | |
| 1041C0700X Social Worker, Clinical (Licence: MA 2020439) | |
| Enumeration Date | 2006-10-15 |
| Last Update Date | 2013-12-03 |