| NPI | 1124625108 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 097453) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VT 089.0136696TELE) |
| 104100000X Social Worker (Licence: NY 110475) | |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06614200) | |
| Enumeration Date | 2020-10-03 |
| Last Update Date | 2026-03-15 |