| NPI | 1669126694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW127803) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VT 089.0136188TELE) |
| 1041C0700X Social Worker, Clinical (Licence: FL TPSW4089) | |
| 1041C0700X Social Worker, Clinical (Licence: WA SWI.LW.70018779) | |
| 1041C0700X Social Worker, Clinical (Licence: NC C019567) | |
| 1041C0700X Social Worker, Clinical (Licence: IL 149.028305) | |
| 1041C0700X Social Worker, Clinical (Licence: CO CSW.09931994) | |
| 1041C0700X Social Worker, Clinical (Licence: CT 16310) | |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06619500) | |
| Enumeration Date | 2022-02-08 |
| Last Update Date | 2026-05-18 |