NPI | 1104200781 |
---|---|
Former Name | MARIAN SULLIVAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 64461) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 115615) |
Enumeration Date | 2015-07-14 |
Last Update Date | 2016-08-25 |