| NPI | 1740717958 |
|---|---|
| Former Name | AMANDA NICHOLE SIMON |
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2019043423) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2017008037) |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2021-07-29 |