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Individual
JALEESA LARA
Active
Individual
JALEESA LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
S09873554
MA
101YM0800X
Mental Health Counselor
S09873554
MA
103T00000X
Psychologist
S09873554
MA
104100000X
Social Worker
S09873554
MA
Other
Enumeration date
09/30/2013
Last updated
09/30/2013
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