NPI | 1780643072 |
---|---|
Former Name | MARY B KENIFIC |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW8791) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 3413) |
Enumeration Date | 2006-03-23 |
Last Update Date | 2011-10-11 |