| NPI | 1811635659 |
|---|---|
| Former Name | JENNIFER WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 096849) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 061999) |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2024-01-29 |