NPI | 1487056495 |
---|---|
Former Name | MARYSA ANTILLON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW78665) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW61688) |
171M00000X Case Manager/Care Coordinator | |
Enumeration Date | 2014-09-22 |
Last Update Date | 2021-07-20 |