| NPI | 1417297797 |
|---|---|
| Former Name | KAITLYN RUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW76692) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW60362) |
| 104100000X Social Worker (Licence: NY 086710) | |
| Enumeration Date | 2013-02-22 |
| Last Update Date | 2018-09-28 |