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NPI Code Detail

MEDICARE: MR. MARK KEANG LY M. ED.

MEDICARE: MR. MARK KEANG LY M. ED.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1366479081
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK KEANG LY M. ED.
Provider Business Mailing Address
First Line : 151 ROCK ST
Second Line :
City : FALL RIVER
State : MA
Zip : 02720-3201
Country : US
Telephone Number : 508-678-7542
Fax Number : 508-676-3699
Provider Business Practice Location Address
First Line : 151 ROCK ST
Second Line :
City : FALL RIVER
State : MA
Zip : 02720-3201
Country : US
Telephone Number : 508-678-7542
Fax Number : 508-676-3699
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2006
Last Update Date : 07/08/2007

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Directions to “ MR. MARK KEANG LY M. ED.” Practice Location

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