| NPI | 1750026886 |
|---|---|
| Former Name | MARY CATHERINE MAE RUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149023338) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2022-05-03 |
| Last Update Date | 2023-03-28 |