| 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 |