| NPI | 1659864890 |
|---|---|
| Former Name | KATRINA MARY NICKERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 121724) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI Isw02639) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2019-09-13 |