NPI | 1780180828 |
---|---|
Former Name | THEODORA ANN STAVRAKAS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 122995) |
Additional Taxonomies | 104100000X Social Worker (Licence: MA 122995) |
1041C0700X Social Worker, Clinical (Licence: WA LW00004297) | |
Enumeration Date | 2018-04-05 |
Last Update Date | 2021-09-02 |