| NPI | 1043645351 |
|---|---|
| Former Name | MALISA MAY PARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 9452542-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-37096) |
| 1041C0700X Social Worker, Clinical (Licence: MT BBH-LCSW-LIC-33625) | |
| 1041C0700X Social Worker, Clinical (Licence: AK 139792) | |
| 1041C0700X Social Worker, Clinical (Licence: WY LCSW-1165) | |
| Enumeration Date | 2013-09-05 |
| Last Update Date | 2019-07-03 |