| NPI | 1013326719 |
|---|---|
| Former Name | SAMANTHA BROOKE PAYTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149022439) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.102587) |
| 104100000X Social Worker (Licence: MO 2014023629) | |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2020-08-20 |