Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Professional |
101YP2500X | |||
Clinical |
1041C0700X | 80 | Licensed Clinical Social Worker |
| NPI # | 1104221019 |
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| LBN Legal business name | HOLISTIC PSYCHOTHERAPY | ||||||||
| Authorized official | JANINA TAURO - (CLINICIAN) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | No | ||||||||
| Enumeration date | 11/04/2014 | ||||||||
| Last updated | 06/29/2015 - About 11 years ago | ||||||||
| Identifiers |
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